加速康复外科对放射性肠炎伴肠梗阻患者外科治疗效果的影响

Effect of enhanced recovery after surgery on the surgical treatment of patients with radiation enteritis and intestinal obstruction

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)对放射性肠炎伴肠梗阻患者外科治疗效果的影响。方法选取解放军总医院第八医学中心普通外科2015年6月至2019年12月期间收治的放射性肠炎伴肠梗阻患者80例的临床资料,采用计算机随机数字法分为观察组和对照组,每组40例。对照组40例实施常规外科治疗联合常规康复干预,观察组40例采用常规外科治疗联合ERAS干预方案。根据血红蛋白(hemoglobin,Hb)及血清白蛋白(albumin,ALB)、前白蛋白(prealbumin,PA)、转铁蛋白(transferrin,TRF)等营养指标变化,并对比两组患者干预前后营养状态;根据白细胞介素2(interleukin-2,IL-2)、白细胞介素6(interleukin-6,IL-6)、白细胞介素8(interleukin-8,IL-8)、超敏C反应蛋白(hypersensitivity C-reactive protein,hs-CRP)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)等指标,对比两组患者干预前后炎性因子变化;对比两组患者干预前后免疫球蛋白(immunoglobulin,Ig)A、G、M等免疫功能变化;观察两组术后恢复情况和术后并发症的发生率。结果干预后观察组Hb(125.56±11.18)g/L、ALB(42.46±3.95)g/L、PA(0.28±0.03)g/L、TRF(2.60±0.30)g/L均高于对照组(102.95±11.12)、(36.28±4.25)、(0.20±0.05)、(2.09±0.27)g/L,差异均有统计学意义(P值均<0.001)。干预后观察组IL-2(3.69±0.79)ng/L、IL-6(15.79±7.17)ng/L、IL-8(6.24±1.25)ng/L、hs-CRP(12.51±2.34)ng/L、TNF-α(1.51±0.68)μg/L均低于对照组(7.26±1.23)ng/L、(23.82±6.95)ng/L、(9.13±1.71)ng/L、(17.63±2.27)ng/L、(2.02±0.81)μg/L,差异均有统计学意义(P值分别为<0.001、<0.001、<0.001、<0.001、0.003)。干预后观察组IgA(1.92±0.63)g/L、IgG(11.36±1.26)g/L、IgM(2.01±0.57)g/L均高于对照组(1.62±0.49)、(9.58±1.23)、(1.60±0.47)g/L,差异均有统计学意义(P值分别为0.020、0.000、0.001)。观察组住院时间(12.1±1.7)d及术后下床时间(1.9±0.6)d、排气时间(3.1±0.4)d均少于对照组(17.2±2.4)、(2.8±1.0)、(4.2±0.8)d,差异均有统计学意义(P值均<0.001)。观察组术后并发症发生率为5.0%(2/40),明显低于对照组的25.0%(10/40),差异有统计学意义(χ^(2)=6.275,P=0.012)。结论对行常规外科治疗的放射性肠炎伴肠梗阻患者给予ERAS干预措施,改善了患者的营养水平、免疫功能及炎性应激反应,提高了患者的治疗效果,缩短了住院时间。

Objective To investigate the effect of enhanced recovery after surgery(ERAS)on the surgical treatment of radiation enteritis with intestinal obstruction.Methods A total of 80 patients with radiation enteritis and intestinal obstruction admitted to the Department of General Surgery,the Eighth Center of Chinese PLA General Hospital from June 2015 to December 2019 were selected and divided into observation group and control group according to the principle of baseline feature matching,with 40 cases in each group.Fourty cases in the control group received conventional surgical treatment combined with conventional rehabilitation intervention,while 40 cases in the observation group received conventional surgical treatment combined with ERAS intervention.According to hemoglobin(HGB),albumin(ALB),prealbumin(PA),transferrin(TRF),the nutritional status of patients in the two groups was compared before and after intervention.According to interleukin-2(IL-2),interleukin-6(IL-6),interleukin-8(IL-8),hypersensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),the changes of inflammatory factors in the two groups was compared before and after intervention.The immunoglobulin(Ig)A,G and M of the two groups was compared before and after intervention.The postoperative recovery and the incidence of postoperative complications was observed in the two groups.Results After the intervention,the level of HGB(125.56±11.18)g/L,ALB(42.46±3.95)g/L,PA(0.28±0.03)g/L and TRF(2.60±0.30)g/L in the observation group was higher than that in the control group(102.95±11.12),(36.28±4.25),(0.20±0.05),(2.09±0.27)g/L,respectively,and the differences between the two groups were significant(all P<0.001).After the intervention,the level of IL-2(3.69±0.79)ng/L,IL-6(15.79±7.17)ng/L,IL-8(6.24±1.25)ng/L,hs-CRP(12.51±2.34)ng/L,TNF-α(1.51±0.68)μg/L in the observation group was lower than that in the control group(7.26±1.23)ng/L,(23.82±6.95)ng/L,(9.13±1.71)ng/L,(17.63±2.27)ng/L,(2.02±0.81)μg/L,respectively,and the differences between the two groups were significant(P<0.001,P<0.001,P<0.001,P<0.001,P=0.003).After the intervention,the level of IgA(1.92±0.63)g/L,IgG(11.36±1.26)g/L,IgM(2.01±0.57)g/L in the observation group was higher than that in the control group(1.62±0.49),(9.58±1.23),(1.60±0.47)g/L,respectively,and the differences between the two groups were significant(P=0.020,<0.001,=0.001,respectively).In the observation group,the hospital stay(12.1±1.7)d,postoperative ambulation time(1.9±0.6)d and exhaust time(3.1±0.4)d was less than that in the control group(17.2±2.4)d,(2.8±1.0)d,(4.2±0.8)d,respectively,and there were significant differences between two groups(all P<0.001).The postoperative complication rate of 5.0%(2/40)in the observation group was significantly lower than 25.0%(10/40)in the control group(χ^(2)=6.275,P=0.012).Conclusion The patients with radiation enteritis and intestinal obstruction treated by conventional surgery were given eras intervention,which improved the nutritional level,immune function and inflammatory stress reaction of the patients,improved the treatment effect of the patients,and shortened the hospitalization time.