加速康复干预对腹腔镜下宫颈癌根治术患者术后恢复及感染的影响

Effect of accelerated recovery intervention after surgery on the postoperative recovery and infection after laparoscopic radical surgery for cervical cancer

目的探讨加速康复干预对腹腔镜下宫颈癌根治术患者术后恢复及感染的影响。方法选取123例行腹腔镜下宫颈癌根治术患者,按照随机数字表法分为对照组61例和观察组62例。对照组患者围手术期采用常规的康复干预,观察组患者围手术期在常规干预的基础上采用加速康复干预。比较两组患者的术后恢复情况(首次下床活动时间、首次排气时间、首次排便时间、术后住院时间)、总住院费用、术后感染的发生情况、术后炎性细胞因子[白细胞介素6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平以及手术前后的免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、CD3^+、CD4^+、CD4^+/CD8^+水平。结果观察组患者术后首次下床活动时间、首次排气时间、首次排便时间、术后住院时间均明显短于对照组(P<0.01),总住院费用明显少于对照组(P<0.01);观察组患者术后7天尿路感染、切口感染、肺部感染的总发生率明显低于对照组(P<0.01);术后14天,观察组患者的IL-6、TNF-α、CRP水平均明显低于对照组(P<0.01);术后7天,观察组患者的IgA、IgM、CD3^+、CD4^+、CD4^+/CD8^+水平均明显高于对照组(P<0.01)。结论与常规的康复干预比较,腹腔镜下宫颈癌根治术患者接受加速康复干预,术后恢复效果更好,可降低术后感染风险,改善免疫功能,值得在临床上推广应用。

Objective To explore the effect of accelerated recovery intervention on the postoperative recovery and infection after laparoscopic radical surgery for cervical cancer.Method The study included 123 patients undergoing laparoscopic radical resection for cervical cancer,who were randomized into two groups as control group(n=61)and study group(n=62)using a random number table,respectively.The control group received conventional perioperative recovery intervention,and the study group adopted the accelerated recovery intervention on the basis of routine intervention.The postoperative recovery of the two groups was compared,including first ambulation time,first flatus time,first defecation time,and postoperative hospital stay,additionally,the total hospitalization expenses,incidence of postoperative infections,changes of inflammatory factors,including interleukin-6(IL-6),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α),and pre-/post-operative level of immunoglobulin A(IgA),IgG,IgM,CD3^+,CD4^+and CD4^+/CD8^+were also compared between the two groups.Result The first ambulation time,first flatus time,first defecation time and postoperative hospitalization time in study group were significantly shorter compared to control group(P<0.01),with less total hospitalization costs(P<0.01);in 7 days after surgery,the total incidence of urinary tract infection,incision infection and pulmonary infection was significantly lower in study group than in control group(P<0.01);in 14 days after surgery,the levels of IL-6,TNF-αand CRP in study group were significantly lower than those in control group(P<0.01);in 7 days after surgery,the IgA,IgM,CD3^+,CD4^+,and CD4^+/CD8^+level in study group were significantly higher compared to control group(P<0.01).Conclusion Compared with conventional recovery intervention,the use of accelerated recovery intervention in patients undergoing laparoscopic radical surgery for cervical cancer obviously promotes the postoperative recovery,reducing the risk of infection after surgery,and improving patients’immune functions.It is worth popularizing and applying in clinic.