ERAS理念对老年结直肠癌患者术后应激反应及并发症的影响

Influence of the Concept of Enhanced Recovery after Surgery(ERAS)on Postoperative Stress Response and Complications in Elderly Patients Undergoing Rectal Cancer Surgery

目的对比分析加速康复外科(enhanced recovery after surgery,ERAS)理念对老年结直肠癌患者术后并发症及应激反应的影响。方法回顾性分析2017年6月至2019年6月锦州医科大学附属第一医院收治的80例老年结直肠癌患者的病历资料,并按照是否采用ERAS理念干预将其分为ERAS组(40例)与非ERAS组(40例),对比观察两组患者术后血栓、吻合口瘘等并发症发生率,首次进食时间,首次排气时间,首次下床活动时间,住院时间,白细胞(WBC)计数,C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平及疼痛视觉模拟评分法(visual analogue scale)评分。结果术后,ERAS组患者并发症发生率为2.5%,与非ERAS组患者并发症发生率7.5%无明显差异(P>0.05);术后,ERAS组患者首次进食时间、首次排气时间、首次下床活动时间及住院时间均明显短于非ERAS组(t=8.589、14.270、2.238、11.680,P=0.000、0.000、0.028、0.000);术后第1、3、5天,ERAS组患者VAS评分、WBC计数及CRP、TNF-α、IL-6水平均明显低于对照组(第1天:t=2.943、2.913、7.186、2.582、4.401,P=0.004、0.005、0.000、0.012、0.000;第3天:t=3.298、3.311、5.603、3.976、7.623,P=0.002、0.001、0.000、0.000、0.000;第5天:t=18.850、4.148、6.678、5.011、5.032,P均=0.000)。结论 ERAS理念可降低老年结直肠癌患者术后并发症发生率,减轻应激反应及疼痛程度,缩短患者住院时间,促进患者术后康复,临床应用价值较高。

Objective To analyze the influence of the concept of enhanced recovery after surgery(ERAS) on postoperative complications and stress responses in elderly patients undergoing rectal cancer surgery.Methods The medical records of 80 elderly patients with rectal cancers,admted to The First Affiliated Hospital of Jinzhou M edical University from June 2017 to June 2019,were retrospectively analyzed.They were then divided,based on whether ERAS intervention was adopted,into ERAS group(40 cases) and non-ERAS group(40 cases).The incidence of complications after surgery,such as thrombus and anastomotic fistula,time of first food intake,time of first exhaust,time of first ambulation,duration of hospitalization,white blood cell(WBC) count,the levels of c-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6) and pain scores were compared between the two groups.Results After surgery,the complication rate of ERAS group was 2.5%,the rate in non-ERAS group was 7.5%,and no significant difference was observed between the two groups(P> 0.05);after surgery,the time of first food intake,time of first exhaust,time of first ambulation and duration of hospitalization in ERAS group were significantly shorter than non-ERAS group(t=8.589,14.270,2.238,11.680,P=0.000,0.000,0.028,0.000);on day 1,3 and 5 after surgery,VAS score,WBC count and the levels of CRP,TNF-α,IL-6 in ERAS group were significantly lower than the control group(Day 1:t=2.943,2.913,7.186,2.582,4.401,P=0.004,0.005,0.000,0.012,0.000;Day 3:t=3.298,3.311,5.603,3.976,7.623,P=0.002,0.001,0.000,0.000,0.000;Day 5:t=18.850,4.148,6.678,5.011,5.032,all P=0.000).Conclusion The concept of ERAS can reduce the incidence of postoperative complications in elderly patients undergoing rectal cancer surgery,reduce degree of stress response and pain,shorten duration of hospitalization and promote postoperative recovery.It has high application value in clinical practice.