快速康复外科对肝胆外科手术患者炎性因子、胃肠激素及胃肠功能的影响

Impact of fast track surgery on inflammatory factors, gastrointestinal hormones, and gastrointestinal function in patients undergoing hepatobiliary surgery

背景肝胆外科手术因复杂的生理与组织解剖结构,手术难度及风险较大,患者会出现强烈的应激反应,影响手术的顺利进行及术后康复效果.快速康复外科通过运用各种经循证医学证实的有效措施,加强围术期过程管理,应用于肝胆外科手术效果值得肯定.但目前还少有从炎性因子、胃肠激素展开比较的文献报道.本研究以炎性因子、胃肠激素为切入点,分析快速康复外科对肝胆外科手术患者胃肠功能的影响的可能作用机制.目的探讨快速康复外科对肝胆外科手术患者炎性因子、胃肠激素及胃肠功能的影响.方法选择2017-05/2018-04拟行肝胆外科手术患者126例为研究对象,随机分为干预组和对照组各63例.对照组给予常规手术管理方法 ,干预组给予快速康复外科管理方法 ,比较两组患者血清炎性因子、胃肠激素、胃肠功能恢复时间、并发症等指标.结果干预组患者血清肿瘤坏死因子-α、C反应蛋白、白细胞介素-6含量明显低于对照组[(36.20±5.32 vs43.55±6.12) pg/mL,(12.42±2.35 vs18.65±3.24) mg/L,(10.24±2.10 vs15.04±2.32)pg/L],差异有统计学意义(t=7.194, 12.355, 12.175, P<0.05, P<0.01);血清胃动素、胃泌素含量明显高于对照组(205.45±25.16vs168.24±24.25,124.32±24.15 vs104.36±20.42)pg/mL,差异有统计学意义(t=8.452,5.009, P <0.05,P <0.01);肠鸣音恢复时间、肛门排气时间、首次排便时间、术后住院时间明显短于对照组[(16.45±3.12 vs21.24±3.65) h,(20.34±4.54 vs41.25±6.12) h,(38.65±5.24 vs57.42±7.15) h,(9.21±1.32 vs13.54±2.12) d)],差异有统计学意义(t=7.918, 21.780, 18.607,13.762, P <0.05, P <0.01);切口感染等并发症9.52%明显低于对照组26.98%(χ~2=6.436, P <0.05).结论快速康复外科有助于促进肝胆外科手术患者胃肠功能恢复,减少并发症的发生,可能与抑制炎症反应、调节胃肠激素等因素有关.

BACKGROUND Hepatobiliary surgery,due to complex physiological and anatomical structures,is difficult and risky,and patients often have a strong stress reaction,which will affect the smooth operation and postoperative rehabilitation.Fast track surgery can strengthen perioperative process management by using various effective measures confirmed by evidence-based medicine,and its application in hepatobiliary surgery is worthy of affirmation.However,there are few studies reporting inflammatory factors and gastrointestinal hormones in patients undergoing hepatobiliary surgery using a fast track surgery program.AIM To study the effect of fast track surgery on inflammatory factors,gastrointestinal hormones,and gastrointestinal function in patients undergoing hepatobiliary surgery.METHODS A total of 126 patients undergoing hepatobiliary surgery from May 2017 to April 2018 were divided into an intervention group and a control group.The control group was given conventional surgical management,and the intervention group given was given fast track surgery management.Serum inflammatory factors,gastrointestinal hormones,gastrointestinal function recovery time,and complications were compared between the two groups.RESULTS Serum tumor necrosis factor-α,C reactive protein,and interleukin-6 were significantly lower in the intervention group than in the control group(36.20 pg/mL±5.32 pg/mL vs 43.55 pg/mL±6.12 pg/mL,12.42 mg/L±2.35 mg/L vs 18.65 mg/L±3.24 mg/L,10.24 pg/L±2.10 pg/L vs 15.04 pg/L±2.32 pg/L;t=7.194,12.355,12.175;P<0.05 or P<0.01).Serum motilin and gastrin were significantly higher in the intervention group than in the control group(205.45 pg/mL±25.16 pg/mL vs 168.24 pg/mL±24.25 pg/mL,124.32 pg/mL±24.15 pg/mL vs 104.36 pg/mL±20.42 pg/mL;t=8.452,5.009;P<0.05,P<0.01).Time to recovery of bowel sounds,time to anal exhaust,time to first defecation,and postoperative hospital stay were significantly shorter in the intervention group than in the control group[16.45 h±3.12 h vs 21.24 h±3.65 h,20.34 h±4.54 h vs 41.25 h±6.12 h,38.65 h±5.24 h vs 57.42 h±7.15 h,9.21 d±1.32 d vs 13.54 d±2.12 d;t=7.918,21.780,18.607,13.762;P<0.05 or P<0.01).The rate of complications such as incision infection was significantly lower in the intervention group than in the control group(9.52%vs 26.98%,χ^2=6.436,P<0.05).CONCLUSION Fast track surgery can promote gastrointestinal function recovery and reduce complications in patients undergoing hepatobiliary surgery,which may be related to inhibiting inflammatory response and regulating gastrointestinal hormones.