加速康复外科对腹腔镜胃癌根治术患者营养状态,免疫功能及炎性因子水平的影响

Effect of Enhanced Recovery after Surgery on Nutritional Status, Immune Function and Inflammatory Factors in Patients with Laparoscopic Radical Gastrectomy for Gastric Cancer

目的:探讨加速康复外科(ERAS)对腹腔镜胃癌根治术患者营养状态,免疫功能及炎性因子水平的影响。方法:将2016年1月~2020年1月于我院行腹腔镜胃癌根治术的胃癌患者166例纳入本研究,按照随机数字表法分为ERAS组(n=83)与对照组(n=83),对照组行常规处理,ERAS组以ERAS处理。观察两组术后1 d、7 d血红蛋白(Hb)、视黄醇结合蛋白(RbP)、转铁蛋白(TRF)、前白蛋白(PRE)、白蛋白(ALB)等营养指标,免疫球蛋白A(Ig A)、免疫球蛋白G(Ig G)、免疫球蛋白M(Ig M)等免疫球蛋白,CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)等T细胞亚群,白介素-6(IL-6)、白介素-8(IL-8)、白介素-10(IL-10)等炎性因子及术后并发症等指标。结果:与术后1 d比较,两组术后7 d Hb、RbP、TRF、PRE、ALB、Ig A、Ig G、Ig M,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均升高,CD8^(+)、IL-6、IL-8、IL-10水平均降低(P<0.05)。术后7 d,ERAS组Hb、RbP、TRF、PRE、ALB、Ig A、Ig G、Ig M、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于对照组,CD8^(+)、IL-6、IL-8、IL-10低于对照组(P<0.05)。ERAS组术后并发症发病率(8.43%)低于对照组(22.89%),差异有统计学意义(P<0.05)。结论:ERAS应用于腹腔镜胃癌根治术中可有效降低患者机体应激反应,改善营养状态,解除免疫抑制,清除炎性因子,减少术后并发症,有助于患者康复。

Objective: To investigate the effect of enhanced recovery after surgery(ERAS) on nutritional status, immune function and inflammatory factors in patients with laparoscopic radical gastrectomy for gastric cancer. Methods: 166 patients with gastric cancer who underwent laparoscopic radical gastrectomy in our hospital from January 2016 to January 2020 were included in this study. They were randomly divided into ERAS group(n=83) and control group(n=83). The control group was treated with routine treatment, and the ERAS group was treated with ERAS. The nutritional indexes such as Hemoglobin(Hb), Retinol binding protein(RbP), Transferrin(TRF),Prealbumin(PRE), Albumin(ALB), Immunoglobulin indexes such as Immunoglobulin A(IgA), Immunoglobulin G(IgG), Immunoglobulin M(Ig M), T cell subsets such as CD3^(+), CD4^(+), CD8^(+), CD4^(+)/CD8^(+), inflammatory factors such as Interleukin-6(Il-6), Interleukin-8(Il-8),Interleukin-10(Il-10) at 1 d and 7 d after operation and postoperative complications were observed. Results: The Hb, RbP,TRF, PRE,ALB, Ig A, Ig G, Ig M, CD3^(+), CD4^(+), CD4^(+)/CD8^(+)levels in the two groups increased and CD8^(+), Il-6, Il-8, Il-10 levels decreased 7 d after the operation compared with 1 d after the operation(P<0.05). 7 d after the operation, the levels of Hb, RbP, TRF, PRE, ALB, Ig A, Ig G, Ig M,CD3^(+), CD4^(+), CD8^(+), CD4^(+)/CD8^(+)in ERAS group were higher than those in Control group, while CD8^(+), Il-6, Il-8, Il-10 were lower than those in Control group(P<0.05). The incidence of postoperative complications in ERAS group(8.43%) was lower than that in Control group(22.89%),the difference was statistically significant(P<0.05). Conclusion: The application of ERAS in laparoscopic radical gastrectomy for gastric cancer can effectively reduce the stress response of patients, improve nutritional status, relieve immunosuppression, eliminate inflammatory factors, reduce postoperative complications and help patients recover.