加速康复外科理念麻醉管理对腹腔镜直肠癌手术患者围手术期应激反应的影响

Effect of enhanced recovery after surgery concept of anesthesia management on perioperative stress responses in patients undergoing laparoscopic rectal cancer surgery

目的 观察加速康复外科(ERAS)理念麻醉管理对腹腔镜直肠癌手术患者围手术期应激反应的影响。方法 行腹腔镜直肠癌手术患者72例随机均分为两组,A组采用ERAS理念麻醉管理,B组采用传统麻醉管理。比较两组麻醉管理质量、围手术期应激反应指标[血清CRP、IL-6、TNF-α水平及促肾上腺皮质激素(ACTH)水平]及其他指标,观察两组术后并发症发生情况。结果 与B组比较,A组术后血清CRP、IL-6、TNF-α及ACTH水平均降低(P<0.01)。与B组比较,A组术后体温升高,VAS疼痛评分降低,体温恢复时间、手术室转出时间、住院时间、胃管留置时间、术后排气时间、术后尿管留置时间及术后禁食时间均缩短(P<0.01)。A组术后并发症发生率低于B组(5.56%vs.25.00%)(P<0.05)。结论 ERAS理念麻醉管理可降低腹腔镜直肠癌手术患者围手术期应激反应,提高麻醉管理质量,减少术后并发症发生。

Objective To observe the effect of enhanced recovery after surgery(ERAS)concept of anesthesia management on perioperative stress response in the patients undergoing laparoscopic rectal cancer surgery.Methods Seventy-two patients undergoing laparoscopic rectal cancer surgery were randomly divided into two groups with 36 cases each.ERAS concept of anesthesia management was given in group A and conventional anesthesia management was given in group B.The quality of anesthesia management,perioperative stress response indicators,including serum levels of CRP,IL-6,TNF-αand adrenocorticotropic hormone(ACTH),and other perioperative indicators were compared between the two groups.The occurrence of postoperative complications was observed.Results Compared with group B,serum levels of CRP,IL-6,TNF-αand ACTH were decreased in group A after operation(P<0.01).Compared with group B,group A had a higher postoperative body temperature,lower VAS pain score,and shorter times of temperature recovery,operating room transfer,hospital stay,gastric tube indentation,postoperative exhaust,postoperative urinary tube indentation and postoperative fasting(P<0.01).The incidence of postoperative complications in group A was lower than that in group B(5.56%vs.25.00%)(P<0.05).Conclusion ERAS concept of anesthesia management can reduce perioperative stress responses,improve the quality of anesthesia management and reduce the postoperative complications in the patients undergoing laparoscopic rectal cancer surgery.