排气饮联合加速康复外科对结直肠癌术后胃肠功能恢复的影响

The Influence of Wind-Breaking Beverage Combined with Enhanced Recovery After Surgery on Gastrointestinal Function Recovery After Colorectal Cancer

目的:观察排气饮联合加速康复外科(enhance recovery after surgery, ERAS)对结直肠癌患者术后胃肠功能的影响。方法:选取江苏省中医院普外科收治的120例行腹腔镜的结直肠癌手术患者,按照随机数字表法分为对照组、ERAS组和排气饮+ERAS组,每组各40例。对照组围手术期给予常规治疗,ERAS组基于ERAS理念给于临床路径干预,排气饮+ERAS组在ERAS组治疗的基础上于术后第1天口服排气饮。观察3组患者首次排气、排便时间、首次肠鸣音恢复时间、术后3 d内肠鸣音速率及肠功能不良事件发生率,比较3组患者手术前后血清白细胞计数(white blood cell, WBC)、C反应蛋白(C reactive protein, CPR)、白细胞介素-6(interleukin-6,IL-6)及视觉模拟疼痛(visual analogue scale, VAS)评分。结果:ERAS组、排气饮+ERAS组首次排气时间、首次排便时间、肠鸣音恢复时间及术后第3天肠鸣音速率小于对照组,且排气饮+ERAS组小于ERAS组,差异有统计学意义(P<0.05)。ERAS组、排气饮+ERAS组术后第1天、术后第3天胃泌素水平高于对照组,且排气饮+ERAS组高于ERAS组,差异具有统计学意义(P<0.05)。术后第3天ERAS组、排气饮+ERAS组WBC、CRP、IL-6水平低于对照组及本组术前1 d,且排气饮+ERAS组低于ERAS组,差异具有统计学意义(P<0.05)。术后第1天VAS疼痛评分无差异,术后第3天ERAS组、排气饮+ERAS组VAS评分低于对照组,且排气饮+ERAS组低于ERAS组,差异具有统计学意义(P<0.05)。3组患者术后非计划再住院率、吻合口瘘、腹腔感染、肠梗阻、恶心呕吐、腹泻等肠功能不良事件发生率比较,差异无统计学意义(P>0.05)。结论:排气饮联合ERAS可促进结直肠癌术后胃肠功能逐步恢复正常,其作用机制可能与控制肠道炎症反应、减轻术后疼痛及胃泌素升高有关。

Objective:To observe the influence of Wind-Breaking Beverage combined with enhanced recovery after surgery(ERAS)on gastrointestinal function after colorectal cancer.Methods:A total of 120 patients with colorectal cancer undergoing laparoscopic surgery were selected from the Department of General Surgery of Jiangsu Province Hospital of Chinese Medicine,and were divided into the con-trol group,the ERAS group and the Wind-Breaking Beverage+ERAS group according to the random number table method,with 40 ca-ses in each group.The control group was given conventional treatment during the perioperative period,the ERAS group was given clini-cal pathway intervention based on the concept of ERAS,and the Wind-Breaking Beverage+ERAS group was given Wind-Breaking Bev-erage for oral administration on the first day after surgery on the basis of the ERAS group.The first exhaust time,defecation time,first bowel sound recovery time,bowel sound rate within 3 days after surgery and the incidence of intestinal dysfunction in the three groups were observed,and the serum white blood cell count(WBC),C reactive protein(CPR),interleukin-6(IL-6)and visual analogue scale(VAS)scores before and after surgery in the three groups were compared.Results:The first exhaust time,first defecation time,bowel sound recovery time and bowel sound rate on the third day after surgery in the ERAS group and the Wind-Breaking Beverage+ERAS group were less than those in the control group,and each time of the Wind-Breaking Beverage+ERAS group was less than that of the ERAS group,with statistically significant differences(P<0.05).The gastrin levels in the ERAS group and the Wind-Breaking Bever-age+ERAS group on the lst and 3rd day after operation were higher than those in the control group,and the gastrin level in the Wind-Breaking Beverage+ERAS group was higher than that in the ERAS group,with statistically significant differences(P<0.05).The lev-els of WBC,CRP and IL-6 in the ERAS group and the Wind-Breaking Beverage+ERAS group on the 3rd day after operation were lower than those in the control group and the Ist day before operation,and the levels of WBC,CRP and IL-6 in the Wind-Breaking Beverage+ERAS group were lower than those in the ERAS group,with statistically significant diferences(P<0.05).There was no difference in the VAS pain score on the 1st day after operation,and the VAS scores in the ERAS group and the Wind-Breaking Beverage+ERAS group on the 3rd day after operation were lower than those in the control group,and the VAS score in the Wind-Breaking Beverage+ERAS group was lower than that in the ERAS group,with statistically significant dfferences(P<0.05).There were no statistically sig-nificant differences in the incidence of postoperative unplanned rehospitalization rate,anastomotic leakage,abdominal infection,intesti-nal obstruction,nausea and vomiting,diarrhea and other intestinal dysfunction among the three groups(P>0.05).Conclusion:Wind-Breaking Beverage combined with ERAS can promote the recovery of gastrointestinal function after colorectal cancer surgery,and its mechanism may be related to controlling intestinal inflammation,reducing postoperative pain and increasing gastrin.