加速康复外科对胆囊结石并胆总管结石患者免疫功能的影响及其机制

Effects of accelerated rehabilitation surgery on immune function in patients with cholecystolithiasis and choledocholithiasis and its molecular mechanism

目的探讨加速康复外科(ERAS)对胆囊结石并胆总管结石患者免疫功能的影响及分子机制。方法选取2022年1月至2023年12月商丘市第一人民医院收治的86例胆囊结石并胆总管结石患者,按照随机数字表格法将患者分为对照组和加速康复组,每组43例。对照组患者行腹腔镜胆囊切除术后常规护理,加速康复组患者在腹腔镜胆囊切除术后给予加速康复外科理念下手术期护理。比较两组患者康复效果以及术后并发生。分别与术前和术后分离患者外周血,采用流式细胞术分析CD4+、CD8+、CD4+/CD8+比值;采用酶联免疫吸附实验(ELISA)分析两组患者血清炎性因子C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)的表达水平;组间比较采用t检验。结果对照组患者术后首次排气时间、胃肠功能恢复时间和住院时间[(29.03±1.77)h、(35.61±2.57)h、(9.57±1.15)d]明显高于加速康复组[(21.15±1.52)h、(26.76±1.61)h,(7.99±0.85)d],差异有统计学意义(t=27.540、22.400、10.490,P<0.05)。对照组患者术后下床活动时间[(24.04±1.33)h]明显低于加速康复组[(30.45±2.08)h],差异有统计学意义(t=20.680,P<0.05)。对照组患者术后CD4+细胞和CD8+细胞比例[(46.62±3.31)%、(24.53±2.35)%]明显高于加速康复组[(38.19±1.65)%、(21.19±2.74)%],差异有统计学意义(t=9.705、6.084,P<0.05)。对照组患者术后免疫细胞CD4+/CD8+细胞比值(2.01±0.22)明显高于加速康复组(1.72±0.22),差异有统计学意义(t=4.093,P<0.05)。对照组患者血清CRP、TNF-α和IL-6水平术[(36.93±2.68)、(92.33±6.94)、(326.15±24.20)pg/ml]明显高于加速康复组[(19.48±1.40)、(58.45±4.44)、(234.81±17.18)pg/ml],差异有统计学意义(t=28.090、20.410、18.610,P<0.05)。结论腹腔镜胆囊切除术后加速康复外科理念提高患者术后免疫功能,降低机体炎症水平,有助于患者术后康复。

ObjectiveTo investigate the effects of accelerated rehabilitation surgery(ERAS)on immune function and its molecular mechanism in patients with cholecystolithiasis and choledocholithiasis.MethodsA total of 86 patients with cholecystolithiasis and choledocholithiasis admitted to our hospital from January 2022 to December 2023 were selected and randomly divided into control group and accelerated rehabilitation group according to the random number table method,with 43 cases in each group.The control group received routine nursing after laparoscopic cholecystectomy,and the accelerated rehabilitation group received postoperative nursing under the concept of accelerated rehabilitation surgery.The recovery effect and postoperative complications were compared between the two groups.Peripheral blood was isolated from patients before and after surgery,and CD4+,CD8+and CD4+/CD8+ratios were analyzed by flow cytometry.Enzyme-linked immunosorbent assay(ELISA)was used to analyze the serum inflammatory factors C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in the two groups.Measurement data were compared by t test.ResultsThe first postoperative exhaust time,gastrointestinal function recovery time and hospital stay in control group[(29.03±1.77)h,(35.61±2.57)h,(9.57±1.15)d]were significantly longer than those in accelerated rehabilitation group[(21.15±1.52)h,(26.76±1.61)h,(7.99±0.85)d,t=27.540,22.400,10.490,P<0.05].The postoperative activity time of patients in control group[(24.04±1.33)h]was significantly shorter than that in accelerated rehabilitation group[(30.45±2.08)h,t=20.680,P<0.05].The ratio of CD4+cells to CD8+cells in control group[(46.62±3.31)%,(24.53±2.35)%]was significantly higher than that in accelerated rehabilitation group[(38.19±1.65)%,(21.19±2.74)%,t=9.705,6.084,P<0.05].The ratio of immune cells CD4+/CD8+in control group(2.01±0.22)was significantly higher than that in accelerated rehabilitation group(1.72±0.22,t=4.093,P<0.05).CRP,TNF-α,and IL-6 levels in control group[(36.93±2.68),(92.33±6.94),(326.15±24.20)pg/ml]were significantly higher than in accelerated rehabilitation group[(19.48±1.40),(58.45±4.44),(234.81±17.18)pg/ml,t=28.090,20.410,18.610,P<0.05].ConclusionThe concept of accelerated rehabilitation surgery after laparoscopic cholecystectomy can improve the postoperative immune function and reduce the level of inflammation,which is conducive to the postoperative rehabilitation of patients.