加速康复外科在老年人胃癌手术中的应用效果及对炎症、营养指标的影响研究

Application of accelerated rehabilitation surgery on elderly patients with gastric cancer and its effects on inflammation and nutritional indicators

分析加速康复外科( ERAS)在老年人胃癌手术中的应用效果及对炎症、营养指标的影响.方法选择2017年10月至2018年10月绍兴市人民医院收治的老年胃癌手术患者80例,按照随机数字表法分为对照组和ERAS组,每组40例.对照组采用传统围术期处理+手术,ERAS组采用ERAS围术期处理+手术.比较分析两组术后恢复和并发症发生情况,术前、术后第1天和术后第3天炎症和营养指标变化及术后生活质量改善情况.结果 ERAS组首次排气时间[(2.3 ±0.8)d]和首次排便时间[(2.5 ±0.4)d]均短于对照组[(3.5 ±0.5)d和(3.7 ±0.6)d],并发症发生率(7.5%)低于对照组(35.0%),差异均有统计学意义(t=8.72、10.52,χ^2 =9.04,均P<0.05). ERAS组术后第1天血清肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)含量分别为(28.3 ±4.9)μg/L和(23.1 ±5.8)μg/L,均低于对照组[(39.8 ±6.7)μg/L和(34.5 ± 8.1)μg/L],差异均有统计学意义(t=8.76、7.24,均P<0.05). ERAS组术后第3天血清TNF-α和IL-6含量分别为(18.4 ±6.2)μg/L和(18.3 ±3.2)μg/L,均低于对照组[(26.2 ±5.1)μg/L和(26.5 ±4.8)μg/L],差异均有统计学意义(t=6.14、8.99,均P<0.05). ERAS组术后第1天血清白蛋白(Alb)和前白蛋白( PRE)含量分别为(31.1 ±0.7)g/L和(161.3 ±7.2)mg/L,均低于对照组[(30.2 ±0.9)g/L和(154.3 ±4.8)mg/L],差异均有统计学意义( t =4.99、5.12,均P<0.05). ERAS 组术后第3 天血清Alb和PRE含量分别为(33.4 ± 0.5)g/L和(172.1 ±5.0)mg/L,均低于对照组[(31.9 ±0.8) g/L和(165.3 ±3.2) mg/L],差异均有统计学意义(t=10.06、7.24,均P <0.05). ERAS 组世界卫生组织生存质量测定量表简表( WHOQOL-BREF)评分[(91.4 ±6.5)分]高于对照组[(80.3 ±7.8)分],差异有统计学意义(P<0.05).结论 ERAS在老年人胃癌手术中的应用效果良好,可维持患者术后炎症和营养状态,值得临床借鉴.

Objective To analyze the application of accelerated rehabilitation surgery in elderly patients with gastric cancer surgery and its influence on inflammation and nutritional indicators .Methods From October 2017 to October 2018,80 elderly patients with gastric cancer who underwent gastrectomy in Shaoxing People 's Hospital were selected.According to random number table method ,they were randomly divided into traditional control group and ERAS group, with 40 cases in each group.The traditional control group was treated by traditional perioperative treatment +operation,while ERAS group was treated with ERAS perioperative treatment +operation.The recovery and complications, inflammation and nutritional changes before operation , 1 day after operation and 3 days after operation,and the improvement of quality of life after operation were compared and analyzed between the two groups . Results In the ERAS group,the first exhaust time[(2.3 ±0.8)d] and defecation time[(2.5 ±0.4)d]were shorter than those in the traditional control group [(3.5 ±0.5)d and (3.7 ±0.6)d],and the incidence rate of complications (7.5%) was lower than that in the traditional control group (35.0%),the differences were statistically significant (t=8.72,10.52,χ^2 =9.04,all P <0.05).On the first day after operation ,the serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin -6(IL-6) in the ERAS group were (28.3 ±4.9)μg/L and (23.1 ± 5.8)μg/L,respectively,which were lower than those in the traditional control group [(39.8 ±6.7)μg/L and (34.5 ± 8.1)μg/L](t=8.76,7.24,all P<0.05).The serum TNF-αand IL-6 levels in the ERAS group on the 3rd day after operation were (18.4 ±6.2)μg/L and (18.3 ±3.2)μg/L,respectively,which were lower than those in the traditional control group[(26.2 ±5.1)μg/L and (26.5 ±4.8)μg/L]( t=6.14,8.99,all P<0.05).The serum levels of albumin (Alb) and prealbumin (PRE) in the ERAS group on the first day after operation were (31.1 ± 0.7)g/L and (161.3 ±7.2) mg/L,respectively,which were lower than those in the traditional control group [(30.2 ± 0.9)g/L and (154.3 ±4.8)mg/L](t=4.99,5.12,all P<0.05).The serum levels of Alb and PRE in the ERAS group on the 3rd day after operation were (33.4 ±0.5)g/L and (172.1 ±5.0)mg/L,respectively,which were lower than those in the traditional control group [(31.9 ±0.8) g/L and (165.3 ±3.2) mg/L](t=10.06,7.24,all P<0.05).The WHOQOL-BREF score of the ERAS group[(91.4 ±6.5)points]was higher than that of the traditional control group[(80.3 ±7.8)points](P<0.05).Conclusion Accelerated rehabilitation surgery has good effect for elderly gastric cancer surgery.It can maintain the inflammation and nutritional status of patients after operation .It is worthy of clinical reference.