麻醉管理中应用快速康复外科理念对腹腔镜直肠癌手术患者应激反应的影响

Influence of Fast-track Surgery Theory in Anesthetic Management on Stress Response of Patients with Laparoscopic Surgery for Rectal Cancer

目的探讨麻醉管理中应用快速康复外科(FTS)策略对腹腔镜直肠癌手术患者应激反应的影响。方法选取择期行腹腔镜直肠癌根治术的患者96例,随机分为FTS组和对照组,每组各48例。FTS组实施一系列FTS策略麻醉管理,对照组给予常规麻醉管理,比较两组围术期相关指标,观察手术前后应激因子水平、T淋巴细胞亚群水平及手术并发症的发生情况。结果FTS组肛门排气时间及住院时间较对照组明显缩短,差异有统计学意义(P<0.05)。术后1 d、3 d两组C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和促肾上腺皮质激素(ACTH)水平较术前1 d明显升高(P<0.01),但FTS组术后3 d上述水平均明显低于对照组(P<0.05)。术后3 d,FTS组CD3^+、CD4^+和CD4^+/CD8^+显著高于对照组,差异有统计学意义(P<0.05或P<0.01)。两组并发症未见显著差异(P>0.05)。结论麻醉管理中应用FTS策略可有效缓解腹腔镜直肠癌手术患者机体应激反应程度,保护机体免疫功能,有利于患者术后快速康复。

OBJECTIVE To explore the influence of fast-track surgery（FTS） strategies in anesthetic management on stress response of patients with laparoscopic surgery for rectal cancer. METHODS A total of 96 patients who received laparoscopic radical resection for rectal cancer on selective days were selected and randomly divided into FTS group and control group, 48 cases for each group. FTS group received a series of FTS strategic anesthetic management, while control group received routine anesthetic management. Peri-operative related indicators were compared between two groups, and stress factor levels, T lymphocyte subgroup levels and occurrence rates of surgical complications were observed before and after surgery. RESULTS FTS group was markedly shorter than control group in anus aerofluxus time and the length of hospital stays, and there were significant differences（P〈0.05）. C-reactive protein（CRP）, tumor necrosis factor-α（TNF-α）, interleukin-6（IL-6）, and adrenocorticotrophic hormone（ACTH） levels were increased prominently on postoperative d1 and d3 than those at preoperative d1（P〈0.01）, but they were significantly lower in FTS group than those in control group on postoperative d3（P〈0.05）. On postoperative d3, FTS group was notably higher than control group in CD3^＋, CD4^＋ and CD4^＋/CD8^＋ levels, and there were significant differences（P〈0.05 or P〈0.01）. There was insignificant difference between two groups in the occurrence rates of complications（P〈0.05）. CONCLUSION Application of FTS strategies in anesthetic management could effectively relieve the stress response severity and protect the body immune function, thus becoming beneficial to the postoperative fast rehabilitation of patients with laparoscopic surgery for rectal cancer.