加速康复外科理念在妇科腹腔镜下全子宫切除术中的应用

Application of the concept of accelerated rehabilitation surgery in laparoscopic total hysterectomy and its effect on stress related hormones after operation

目的比较实施加速康复外科理念与传统外科理念对妇科腹腔镜下全子宫切除术患者围术期的效果及对术后机体应激相关激素的影响,探讨加速康复外科理念的临床应用价值。方法选取2018年9月至2019年3月徐州医科大学附属医院诊治的100例行腹腔镜下全子宫切除术治疗的患者作为研究对象。按照随机原则分为两组,分别为观察组(n=50)和对照组(n=50),观察组患者围手术期予加速康复外科管理模式,对照组患者予传统外科理念,比较两组患者应激相关激素(皮质醇、促肾上腺皮质激素、β-内啡肽)的水平及术后并发症的发生情况。结果两组患者术前应激相关激素(皮质醇、促肾上腺皮质激素和β-内啡肽)比较,差异无统计学意义(P>0.05)。术后24h两组患者应激相关激素(皮质醇、促肾上腺皮质激素和β-内啡肽)均较术前上升,差异均具有统计学意义(均P<0.05),术后72h均较术后24h有所下降,差异均具有统计学意义(均P<0.05)。观察组患者应激相关激素(皮质醇、促肾上腺皮质激素和β-内啡肽)的水平较对照组患者均降低,差异均具有统计学意义(均P<0.05),观察组术后24h排气率比对照组高,腹胀的发生率较对照组低。结论在妇科腹腔镜下全子宫切除术中实施加速康复外科理念,可以减轻患者术后应激相关激素(皮质醇、促肾上腺皮质激素和β-内啡肽)的上升程度,减轻患者术后的应激状态,减少术后并发症的发生,值得临床推广应用。

Objective To compare the effect of implementing the concept of accelerated rehabilitation surgery and the traditional surgical concept on the perioperative period of patients received laparoscopic total hysterectomy(LTH)and the effect on stress related hormones after surgery,and to explore the clinical application value of accelerated rehabilitation surgery.Methods 100 patients received LTH in Affiliated Hospital of Xuzhou Medical University from September 2018 to March 2019 were selected,and in accordance with the principle of random divided into the accelerated rehabilitation surgery group(observation group)and conventional treatment group(control group),50 cases in each group.The levels of stress-related hormones(cortisol and adrenocorticotropic hormone,beta-endorphin)and the occurrence of postoperative complications were compared between the two groups.Results There was no statistically significant difference in preoperative stress-related hormones(cortisol,corticotrophin,and beta-endorphin)between the two groups(P>0.05).The stress-related hormones in the two groups increased at 24 h after the operation and decreased at 72 h after the operation,all with statistically significant differences(all P<0.05).The levels of stress-related hormones in the observation group were all reduced compared with those in the control group,with statistically significant differences(all P<0.05).At 24 hours after the operation,the exhaust rate of the observation group was higher,and the incidence of abdominal distension was lower in the observation group than that of the control group accordingly.Conclusions The concept of accelerated rehabilitation surgery in LTH can reduce the increase of stress related hormones,the postoperative stress state of patients,and the occurrence of postoperative complications,which is worthy of clinical application.