加速康复外科对胃癌合并2型糖尿病患者手术应激反应的影响

Effect of enhanced recovery after surgery on surgical stress response in patients with gastric cancer complicated with type 2 diabetes mellitus

目的:探究加速康复外科(ERAS)对胃癌合并2型糖尿病患者手术应激反应的影响。方法:回顾性分析2020年1至12月江苏大学附属医院胃肠外科收治的49例行胃癌根治术的2型糖尿病患者的临床资料,依据围手术期不同的处理措施分为试验组[23例,男17例,女6例,年龄(67.6±8.7)岁)]与对照组[26例,男17例,女9例,年龄(66.2±8.4)岁]。对比两组患者围手术期的C反应蛋白(CRP)、白细胞(WBC)、白细胞介素-6(IL-6)、胰岛素抵抗水平(HOMA-IR)、血糖波动状况以及术后恢复情况。结果:最终共有49例患者纳入研究。术后试验组的应激反应程度较对照组轻,CRP水平在术后第5天[(17.3±9.2)比(28.7±18.0)mg/L,P=0.009]、第7天[(6.7±4.3)比(15.5±11.1)mg/L,P=0.001)差异均有统计学意义;两组IL-6在术后第1天[(28.0±10.0)与(35.7±15.5)ng/L,P=0.047]、第3天[(14.6±8.6)与(26.4±10.8)ng/L,P<0.001]、第5天[(10.8±7.1)与(21.6±12.2)ng/L,P<0.001]、第7天[(9.6±7.2)与(14.3±8.2)ng/L,P=0.039]差异均有统计学意义;术后第1天两组WBC、HOMA-IR差异均有统计学意义(均P<0.05),其中试验组的HOMA-IR、血糖的整体变化趋势较对照组的更为平缓。试验组术后肛门首次排气时间、引流管留置时间、鼻肠管留置时间、术后住院时间等均较对照组明显缩短,差异均有统计学意义(均P<0.05)。结论:ERAS可减轻胃癌合并2型糖尿病患者手术的炎症应激程度,降低术后HOMA-IR水平,促进早期康复。

Objective To investigate the effect of enhanced recovery after surgery on the stress response of gastric cancer patients complicated with type 2 diabetes mellitus.Methods We retrospectively analyzed the data of 49 patients with type 2 diabetes who underwent radical gastrectomy for gastric cancer in the Department of gastroenterology of the Affiliated Hospital of Jiangsu University from Jan to Dec 2020.They were randomly divided into experimental group and control group according to different perioperative management measures.The perioperative C-reactive protein(CRP),white blood cell(WBC),interleukin-6(IL-6),insulin resistance(HOMA-IR),blood glucose fluctuation and postoperative recovery were compared between the two groups.Results A total of 49 patients were enrolled in the study(23 in the experimental group and 26 in the control group).The degree of stress reaction of the experimental group was lighter than that of the control group.The levels of CRP were significantly different on the 5th and 7th day after operation,IL-6 was significantly different on the 1st,3rd,5th and 7th day after operation,WBC and HOMA-IR were significantly different on the 1st day postoperatively.And the changes of HOMA-IR and blood glucose in experimental group were more gentle than those in control group.All the differences were statistically significant(P<0.05).In the experimental group,the time of first anal exhaust,indwelling time of drainage tube or nasointestinal tube and the total hospitalization time were significantly shorter than those of the control group(P<0.05).Conclusion ERAS can reduce the degree of inflammatory stress and the postoperative IR level promote the early recovery of patients with gastric cancer complicated with type 2 diabetes mellitus.