快速康复外科理念对乳腺癌患者围手术期胰岛素抵抗和炎症反应的影响

Impact of Fast Track Surgery Concept on Perioperative Insulin Resistance and Inflammatory Response in Patients with Breast Cancer

目的:观察快速康复外科理念对乳腺癌患者的疗效,及其对机体胰岛素抵抗和炎症反应的影响。方法:选择2017年1月至2019年12月在我院诊治的乳腺癌患者96例,按照随机数字方法将患者分为观察组和对照组,每组各48例。对照组围手术期采用常规干预,观察组在对照组的基础上采用快速康复外科理念干预。比较两组术后疗效、临床指标和并发症发生率,观察两组术前术后空腹血糖(FBG)、空腹胰岛素(FINS)、稳态模型评估法胰岛素抵抗(HOMA-IR),血清核因子κB(NF-κB)、肿瘤坏死因子(TNF)-α和白介素(IL)-6的变化。结果:观察组的总有效率为95.83%,高于对照组的79.17%(χ2=2.469,P<0.05)。观察组的并发症发生率为10.42%,低于对照组的29.17%(χ2=2.306,P<0.05)。观察组的进食时间、下床时间、引流时间、切口愈合时间和住院时间短于对照组(P<0.01)。两组术前FBG,FINS,HOMA-IR,NF-κB,TNF-α和IL-6水平差异无统计学意义(P>0.05),术后两组以上指标均较术前升高(P<0.01),而对照组的升高水平较观察组更为明显(P<0.01)。结论:快速康复外科理念应用到乳腺癌患者围手术期中,能够明显提高疗效,降低并发症发生率,缓解围手术期的炎症反应和胰岛素抵抗。

Objective:To observe the efficacy of Fast Track Surgery concept in patients with breast cancer and its impact on the patients′insulin resistance and inflammatory response.Methods:96 patients with breast cancer treated in our hospital from January 2017 to December 2019 were divided into the observation group and the control group according to random number method,and each group 48 cases.The control group used routine intervention during the perioperative period,and observation group was performed with Fast Track Surgery concept on the basis of the control group.The postoperative efficacy,clinical indicators and complication rate were observed between the two groups,and the fasting blood glucose(FBG),fasting insulin(FINS),homeostatic model assessment for insulin resistance(HOMA-IR),and nuclear factorκB(NF-κB),tumor necrosis factor(TNF)-α,and interleukin(IL)-6 were also observed in the two groups before and after surgery.Results:The total effective rate was 95.83%in the observation group,which was higher than 79.17%in the control group(χ2=2.469,P<0.05).The complication rate was 10.42%in the observation group,which was significantly lower than 29.17%in the control group(χ2=2.306,P<0.05).The feeding time,out of bed time,drainage time,incision healing time and hospital stay time in the observation group were shorter than those in the control group(P<0.01).There was no significant difference of FBG,FINS,HOMA-IR,NF-κB,TNF-αand IL-6 before surgery in the two groups(P>0.05).After surgery,the levels of those indicators in the two groups were higher than those before surgery(P<0.01),while the increase in the control group was more obvious compared with the observation group(P<0.01).Conclusion:Perioperative intervention with Fast Track Surgery concept in patients with breast cancer can improve the efficacy,reduce the incidence of complications,and alleviate the inflammatory response and insulin resistance during perioperative period.