加速康复外科理念对结直肠癌合并糖尿病患者术后应激反应和并发症的影响

Effect of enhanced recovery after surgery concept on postoperative stress response and complications in patients with colorectal cancer complicated with diabetes

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念对结直肠癌合并糖尿病患者术后应激反应及并发症的影响。方法选取2018年1月至2021年12月于金华市人民医院行经腹结直肠癌根治术且合并糖尿病的患者102例,根据围手术期处理方法不同将患者分为对照组和观察组,每组各51例。对照组患者给予常规围手术期处理,观察组患者给予ERAS理念指导下的围手术期处理,比较两组患者手术前后的应激反应指标[C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、皮质醇(cortisol,Cor)]及术后并发症发生率。结果两组患者的术前血清CRP、IL-6、Cor水平比较差异均无统计学意义(P>0.05);手术后,两组患者的血清CRP、IL-6、Cor水平均显著高于本组术前(P<0.01),但观察组患者的血清CRP、IL-6、Cor水平均显著低于对照组(P<0.01);观察组患者的总并发症发生率显著低于对照组(7.8%vs 47.1%,χ2=9.887,P<0.05)。结论采用ERAS理念对结直肠癌合并糖尿病患者进行围手术期处理,可减轻患者的应激反应,降低并发症发生率,具有临床推广应用价值。

Objective To investigate the effect of enhanced recovery after surgery(ERAS)on postoperative stress response and complications in patients with colorectal cancer complicated with diabetes.Methods From January 2018 to December 2021,102 patients with diabetes who underwent transabdominal radical resection of colorectal cancer in Jinhua People’s Hospital were selected.According to different perioperative treatment methods,the patients were divided into control group and observation group,51 cases in each group.Patients in control group were given routine perioperative management,while patients in observation group were given perioperative management guided by ERAS concept.The stress response indicators[C-reactive protein(CRP),interleukin-6(IL-6),cortisol(Cor)]before and after surgery and the incidence of postoperative complications were compared between the two groups.Results There were no significant differences in preoperative serum CRP,IL-6 and Cor levels between the two groups(P>0.05).After surgery,the levels of serum CRP,IL-6 and Cor in two groups were significantly higher than those before surgery(P<0.01),but the levels of serum CRP,IL-6 and Cor in observation group were significantly lower than those in control group(P<0.01).The total complication rate of observation group was significantly lower than that of control group(7.8%vs 47.1%,χ2=9.887,P<0.05).Conclusion ERAS concept in perioperative management of patients with colorectal cancer complicated with diabetes can reduce the stress response of patients,reduce the incidence of complications,and has clinical application value.