快速康复外科对腹腔镜结肠癌手术患者康复进程、营养状态及炎性反应的影响

Effects of fast track surgery on the rehabilitation process,nutritional status and inflammatory response of patients with laparoscopic colon cancer surgery

目的探讨快速康复外科(FTS)对腹腔镜结肠癌手术患者康复进程、营养状态及炎性反应的影响。方法选取118例结肠癌患者,将2018年1月至2019年5月应用常规干预措施的59例结肠癌患者作为常规组,将2019年6月至2021年1月应用FTS干预措施的59例结肠癌患者作为FTS组。比较两组患者的胃肠功能恢复指标、炎性反应指标[降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、营养状态指标[转铁蛋白(TRF)、白蛋白(ALB)、前白蛋白(PAB)]、康复进程指标和并发症发生情况。结果FTS组患者禁食时间、肠鸣音恢复时间、首次排气时间、首次排便时间均明显短于常规组(P﹤0.01)。术后3天,两组患者CRP、PCT、IL-6、TNF-α水平均高于本组术前,但FTS组患者CRP、PCT、IL-6、TNF-α水平均低于常规组,差异均有统计学意义(P﹤0.05)。出院前,两组患者TRF、ALB、PAB水平均高于本组术前,且FTS组患者TRF、ALB、PAB水平均高于常规组,差异均有统计学意义(P﹤0.05)。FTS组患者术后48 h视觉模拟评分法(VAS)评分明显低于常规组,首次下床活动时间、输液时间、住院时间均明显短于常规组,差异均有统计学意义(P﹤0.01)。两组患者术后并发症总发生率比较,差异无统计学意义(P﹥0.05)。结论FTS能够加快腹腔镜结肠癌手术患者的术后康复,促进患者胃肠功能的恢复,有效改善患者的营养状态,减轻炎性反应。

Objective To investigate the effect of fast track surgery(FTS)on the recovery process,nutritional status and inflammatory response of patients undergoing laparoscopic colon cancer surgery.Method A total of 118 colon cancer patients were selected.59 colon cancer patients who applied routine intervention measures from January 2018 to may 2019 were taken as the routine group,and 59 colon cancer patients who applied FTS intervention measures from June 2019 to January 2021 were taken as the FTS group.The gastrointestinal function recovery indexes,inflammatory response indexes[procalcitonin(PCT),C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],nutritional status indexes[transferrin(TRF),albumin(ALB),prealbumin(PAB)],rehabilitation progress indexes and complications were compared between the two groups.Result The fasting time,bowel sound recovery time,first flatus time,and first defecation time in the FTS group were significantly shorter than those in the routine group(P<0.01).Three days after operation,the levels of CRP,PCT,IL-6 and TNF-αin the two groups were higher than those before operation in the same group,but the levels of CRP,PCT,IL-6 and TNF-αin the FTS group were lower than those in the routine group,and the differences were statistically significant(P<0.05).Before discharge,the levels of TRF,ALB,and PAB in the two groups were higher than those before surgery,and the levels of TRF,ALB,and PAB in the FTS group were higher than those in the routine group,and the differences were statistically significant(P<0.05).The visual analogue scale(VAS)score at 48 hours after the operation in the FTS group was significantly lower than that in the routine group,and the time to get out of bed for the first time,infusion time,and hospital stay were significantly shorter than those in the routine group,and the differences were statistically significant(P<0.01).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).Conclusion FTS can accelerate the postoperative recovery of patients with colon cancer laparoscopic surgery,promote the recovery of gastrointestinal function,effectively improve the nutritional status of patients,and reduce inflammatory reactions.