术后快速康复管理对结直肠癌患者围手术期胰岛素抵抗影响的研究

Effect of enhanced recovery after surgery on the perioperative insulin resistance in patients with colorectal cancer

目的探讨术后快速康复(ERAS)管理模式对结直肠癌患者围手术期胰岛素抵抗(IR)的影响。方法回顾性分析92例腹腔镜结直肠癌手术患者的临床资料。根据围手术期管理模式不同,分为对照组(传统管理模式)46例和观察组(ERAS管理模式)46例。比较两组患者手术前后空腹血糖(FBG)水平、空腹胰岛素(FINS)水平。采用稳态模型评估法(HOMA)计算并比较IR指数(简称HOMA-IR)。结果两组患者手术前后不同时间点组间FBG水平比较,差异无统计学意义(F=3.535,P>0.05);但术后1天,观察组患者的FBG水平低于对照组,差异有统计学意义(t=2.267,P<0.05)。两组患者手术前后不同时间点组间FINS水平比较,差异有统计学意义(F=175.365,P<0.01);术后1、3天,观察组患者的FINS水平均明显低于对照组(t=24.037、9.328,P<0.01)。两组患者手术前后不同时间点组间HOMA-IR比较,差异有统计学意义(F=71.758,P<0.01);术后1、3天,观察组患者的HOMA-IR均明显低于对照组(t=12.351、5.774,P<0.01)。结论 ERAS管理可以明显降低腹腔镜结直肠癌患者的HOMA-IR,对促进患者机体康复具有重要的意义,值得临床借鉴。

Objective To investigate the effects of enhanced recovery after surgery （ERAS） on perioperative insulin resistance （IR） in patients with colorectal cancer. Method The retrospective analysis included 92 cases of colorectal can- cer treated with laparoscopic surgery, who were divided according to the perioperative management as control group （with conventional management） 46 cases and study group （with ERAS management） 46 cases. The fasting blood glucose （FBG） level, and fasting insulin （FINS） level before and after surgery in both groups were compared. Homeostasis model assessment （HOMA） was applied to calculate IR index （HOMA-IR）.Result There was no significant difference in FBG level at different time points before and after surgery between the two groups （F=3.535, P〉0.05）; however, the FBG level in study group was lower than that in control group in 1 day after surgery （t=-2.267, P〈0.05）. The FINS level at various time points before and after surgery in the two groups showed significant difference （F= 175.365, P〈0.01）; and in 1 and 3 days after surgery, the FINS level in study group were significantly lower than those in control group （t=-24.037, 9.328, P〈 0.01）. Furthermore, HOMA-IR at different time points before and after surgery indicated dissimilar trend, with statistically significant differences observed （F=71.758, P〈0.01）; and the HOMA-IR in study group was significantly lower than that in control group in 1 and 3 days after operation （t=-12.351, 5.774, P〈0.01）. Conclusion ERAS management can significantly reduce the HOMA-IR in colorectal cancer patients who had laparoscopic treatment, and it is essentially beneficial to promote the recovery for patients.