加速康复外科干预对口腔癌患者术后营养状况、炎性指标、血糖波动和康复情况的影响

Effect of Enhanced Recovery after Surgery Intervention on Postoperative Nutrition, Infammatory Indicators, Glucose Variability and Rehabilitation of Patients with Oral Cancer

目的探讨加速康复外科(enhanced recovery after surgery, ERAS)干预对口腔癌患者术后营养状况、炎性指标、血糖波动和康复情况的影响。方法选取口腔癌156例作为研究对象,根据干预措施不同将其分为试验组和对照组两组各78例。试验组采用ERAS干预,对照组采用常规处理。观察比较两组手术前后营养状况指标、炎性指标、血糖波动值及术后康复指标。结果术前1 d,两组营养状况指标、炎性指标和血糖波动值比较差异均无统计学意义(P>0.05)。术后5、10和15 d,试验组血清白蛋白、转铁蛋白、前白蛋白及血红蛋白水平均高于对照组,血清白细胞介素6、C反应蛋白、肿瘤坏死因子α及血糖波动值均低于对照组,差异有统计学意义(P<0.05或P<0.01)。术后15 d,试验组切口感染、口臭、肺炎、胃肠道功能紊乱、尿路感染、中度疼痛发生率及首次下床活动时间、输液时间、住院时间、住院费用、焦虑自评量表评分均低于或短于对照组,差异有统计学意义(P<0.05或P<0.01)。结论口腔癌患者采用ERAS干预可明显改善术后营养状况、炎症反应及血糖波动值,且可降低术后并发症发生率,缩短首次下床活动时间、输液时间、住院时间,减少住院费用,改善心理状态。

Objective To investigate the effects of enhanced recovery after surgery(ERAS) intervention on postoperative nutritional status, inflammatory indicators, blood glucose variability and rehabilitation of patients with oral cancer. Methods A total of 156 cases of oral cancer were selected as subjects and divided into experimental group(n=78) and control group(n=78) according to different intervention methods. ERAS intervention was used in the experimental group and conventional treatment was used in the control group. Nutritional status indicators, inflammatory indicators, blood glucose variability and postoperative rehabilitation index were observed and compared between the two groups. Results At 1 d before operation, there was no statistically significant difference in nutritional status indicators, inflammatory indicators and blood glucose variability between the two groups(P>0.05). At 5, 10 and 15 d after operation, the serum albumin, transferrin, prealbumin, and hemoglobin in the experimental group were higher than those in the control group, and the serum interleukin-6, C-reactive protein and tumor necrosis factor and blood glucose variability were significantly lower than those in the control group(P<0.05 or P<0.01). Before and after operation, the nutritional status indicators of the two groups showed the tendency of falling after rising. The incidence of incision infection, bad breath, pneumonia, gastrointestinal dysfunction, urinary tract infection, moderate pain, and the first time of leaving bed, infusion duration, length of hospitalization, hospitalization cost, and self-rating anxiety scale in the experimental group were all significantly lower or shorter than those in the control group(P<0.05 or P<0.01). Conclusion ERAS intervention can significantly improve postoperative nutritional status, inflammatory response and blood glucose variability in patients with oral cancer, and reduce the incidence of postoperative complications. In addition, it can shorten the first time of leaving bed, infusion duration and length of hospitalization, reduce hospitalization costs and improve psychological state.