加速康复外科理念在腹腔镜结直肠癌围手术期中的应用效果观察

Effect of enhanced recovery after surgery in perioperative stage of laparoscopic colorectal cancer surgery

目的探讨基于加速康复外科(ERAS)理念的手术室护理干预对腹腔镜结直肠癌手术患者手术应激反应和术后并发症的影响。方法采用随机数字表法将110例腹腔镜结直肠癌手术患者分为观察组和对照组,每组55例。对照组给予手术室常规护理干预,观察组给予基于ERAS理念的手术室护理干预。比较两组患者术前和术中的生理应激指标[收缩压(SBP)、舒张压(DBP)、肾上腺素(E)、去甲肾上腺素(NE)、心率(HR)]、术前1天和术后3天的炎性因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)]水平、围手术期相关指标以及术后并发症发生情况。结果术中,两组患者的SBP、DBP、E、NE、HR水平均高于本组术前(P﹤0.05);术中,对照组患者的上述指标水平均明显高于观察组患者(P﹤0.01)。术后3天,观察组患者的IL-6、CRP、TNF-α水平均低于对照组患者(P﹤0.05)。观察组患者的术后首次排气时间、首次进食时间、首次排便时间、术后住院时间均短于对照组患者,术后并发症的总发生率低于对照组患者(P﹤0.05)。结论对腹腔镜结直肠癌手术患者实施基于ERAS理念的手术室护理干预,可减轻患者术中、术后的应激反应,促进患者胃肠道功能的恢复,减少术后并发症的发生,值得临床推广应用。

Objective To investigate the effects of enhanced recovery after surgery(ERAS)on the stress response and postoperative complications of laparoscopic colorectal cancer surgery.Method A total of 110 patients receiving laparoscopic colorectal cancer surgery were enrolled and randomly divided into the research as study group and control group,with 55 cases in each.The control group was given routine operating room nursing care,and the study group was administered with operating room nursing care based on ERAS concept.The two groups were compared for pre-and intra-operative physiological stress indexes[systolic blood pressure(SBP),diastolic blood pressure(DBP),epinephrine(E),norepinephrine(NE),heart rate(HR)],inflammatory factor level in 1 day before surgery and 3 days after surgery[interleukin-6(IL-6),C reactive protein(CRP),tumor necrosis factor-α(TNF-α)],as well as the perioperative indexes and incidence of complications.Result During surgery,the physiological stress indexes,including SBP,DBP,E,NE and HR in the two groups were higher compared with those before surgery(P<0.05);besides,these indicators in control group were also significantly higher compared to study group during surgery(P<0.01).In 3 days after surgery,the levels of IL-6,CRP and TNF-αstudy group were significantly lower than those in control group(P<0.05).The first flatus time,first feeding time,first defecation time,and postoperative hospital stay were shorter in study group than in control group,with lower overall incidence of postoperative complications observed in study group than that in control group(P<0.05).Conclusion The application of operating room nursing care based on ERAS concept for patients with laparoscopic colorectal cancer receiving laparoscopic surgery can markedly alleviate the intraoperative and postoperative stress response,accelerate the recovery of gastrointestinal function,and reduce the complications of surgery.