Effect of enhanced recovery after surgery on prognosis and inflammatory response of patients undergoing laparoscopic colorectal cancer surgery
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摘要:目的 探讨快速康复外科（ERAS）方案对腹腔镜结直肠癌手术患者预后及炎症反应的影响。方法 选取80例择期行腹腔镜下结直肠癌切除术的患者作为研究对象，随机分为对照组和研究组，每组40例。对照组按照传统方案实施围术期管理，研究组按照ERAS方案实施围术期管理。比较2组患者术前（T1时点）、术后12 h（T2时点）、术后24 h（T3时点）和术后48 h（T4时点）的血清炎症因子[白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）]水平，并比较2组术中出血量、围术期阿片类药物使用剂量、腹腔引流管放置时间和术后排气排便时间、住院时间、视觉模拟评分法（VAS）评分、并发症发生情况。结果 T2、T3、T4时点，2组血清炎症因子水平均高于T1时点，差异有统计学意义（P < 0.05）；T1时点，2组血清炎症因子水平差异无统计学意义（P>0.05）；T2、T3、T4时点，研究组血清炎症因子水平均低于对照组，差异有统计学意义（P < 0.05）。研究组围术期阿片类药物使用剂量少于对照组，腹腔引流管留置时间、术后住院时间短于对照组，术后VAS评分、并发症发生率低于对照组，差异有统计学意义（P < 0.05）。结论 ERAS方案应用于腹腔镜结直肠癌手术患者中能有效降低患者炎症因子水平，减轻疼痛，缩短住院时间，减少术后并发症的发生。Abstract:Objective To compare the effects of enhanced recovery after surgery (ERAS) on prognosis and inflammatory response of patients undergoing laparoscopic colorectal cancer surgery.Methods Eighty patients who underwent elective laparoscopic resection of colorectal cancer were selected as research subjects and randomly divided into control group (n=40) and study group (n=40). The control group was given perioperative management according to the traditional scheme, while the study group was given perioperative management based on ERAS. Serum levels of inflammatory cytokines[interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α)]at time points of preoperation (T1), postoperative 12 hours (T2), postoperative 24 hours (T3), and postoperative 48 hours (T4) of two groups were compared. The amount of intraoperative blood loss, perioperative dose of opioids, indwelling time of abdominal drainage tube and postoperative exhaust defecation, length of hospital stay, Visual Analog Scale (VAS) score and incidence of complications were compared between the two groups.Results Compared with T1, the serum levels of inflammatory factors at time points of T2 to T4 were significantly higher (P < 0.05). At T1, there was no significant difference in serum inflammatory cytokines between the two groups (P>0.05). The serum inflammatory factors of the study group at T2, T3 and T4 were significantly lower than those in the control group (P < 0.05). Compared with the control group, the perioperative opioid dosage of the study group was significantly less, indwelling time of abdominal drainage tube and postoperative hospitalization time were shorter, and postoperative VAS score and complication rate were significantly lower than the control group than those of the control group (P < 0.05).Conclusion ERAS for patients undergoing laparoscopic colorectal cancer surgery can effectively reduce the level of inflammatory factors, relieve pain, shorten the length of hospital stay and reduce the incidence of postoperative complications.
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Keywords:
- rapid rehabilitation /
- laparoscope /
- inflammatory factors /
- colorectal cancer
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表 1 2组患者一般资料比较(x±s)
指标 对照组(n=40) 研究组(n=40) t/χ2 P 性别 男 19(47.50) 22(55.00) 0.450 0.502 女 21(52.50) 18(45.00) 年龄/岁 58.83±6.48 60.77±5.92 1.398 0.166 身高/cm 163.21±6.81 161.74±5.79 1.040 0.302 体质量/kg 60.54±10.24 58.59±9.28 0.892 0.374 术前肺功能 FEV1/L 2.73±0.74 2.66±0.65 0.449 0.654 FEV1/FVC/% 80.04±8.90 79.14±7.83 0.480 0.632 MVV/(L/min) 69.76±15.68 71.13±14.37 0.407 0.685 FEV1: 第1秒用力呼气容积; FEV1/FVC: 第1秒用力呼气容积与用力肺活量比值; MVV: 最大通气量。 
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表 2 2组患者手术指标比较(x±s)
指标 对照组(n=40) 研究组(n=40) 手术时间/min 155.76±21.25 146.59±17.72 麻醉时间/min 171.45±25.98 165.23±26.23 潮气量/mL 468.51±25.54 420.43±18.61* 补液量/mL 晶体液 635.21±21.54 578.65±28.36* 胶体液 583.93±27.22 427.64±32.41* 术中出血量/mL 112.33±34.87 70.63±26.89* 丙泊酚使用剂量/mg 1 163.67±57.86 1 157.38±42.05 芬太尼使用剂量/μg 250.23±12.42 232.65±10.61* 瑞芬太尼使用剂量/mg 0.75±0.13 0.57±0.11* 与对照组比较, *P < 0.05。
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表 3 2组患者术后VAS评分比较(x±s)
分 时点 对照组(n=40) 研究组(n=40) 术后1 d 3.66±0.27 2.63±0.31* 术后2 d 3.01±0.25 2.25±0.20* 术后3 d 3.51±0.30 2.15±0.27* 术后4 d 2.65±0.21 1.75±0.23* 术后5 d 2.10±0.18 1.65±0.21* VAS: 视觉模拟评分法。与对照组比较, *P < 0.05。
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表 4 2组患者术后住院情况及并发症比较(x±s)[n(%)]
指标 对照组(n=40) 研究组(n=40) 腹腔引流管留置时间/d 4.89±0.14 4.11±0.12* 导尿管留置时间/h 8.19±0.35 7.86±0.38* 术后首次排气时间/d 4.33±1.28 3.06±0.83* 术后首次排便时间/d 4.68±1.33 3.52±1.04* 术后住院时间/d 7.52±2.51 5.73±2.15* 术后并发症 13(32.50) 5(12.50)* 与对照组比较, *P < 0.05。
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表 5 2组患者各时点血清炎症因子水平比较(x±s)
pg/mL 炎症因子 时点 对照组(n=40) 研究组(n=40) IL-1β T1 5.65±2.36 6.53±2.23 T2 27.58±3.32* 17.86±2.30*# T3 18.43±3.57* 11.76±3.96*# T4 14.69±2.38* 8.92±1.72*# IL-6 T1 11.63±7.08 9.97±6.09 T2 28.89±8.64* 22.44±6.35*# T3 25.26±6.28* 18.89±5.43*# T4 23.08±7.12* 15.74±6.17*# IL-8 T1 46.59±9.87 44.67±11.05 T2 93.78±23.27* 72.36±18.76*# T3 67.78±20.12* 52.76±17.28*# T4 62.10±8.83* 50.49±11.29*# IL-10 T1 21.34±8.68 20.14±5.62 T2 53.29±14.13* 38.65±11.56*# T3 42.70±8.16* 30.82±7.37*# T4 39.12±8.81* 26.54±7.21*# TNF-α T1 43.84±11.85 39.82±12.15 T2 99.63±13.82* 83.78±16.90*# T3 86.47±8.16* 71.92±10.94*# T4 70.54±8.83* 63.31±5.78*# IL-1β: 白细胞介素-1β; IL-6: 白细胞介素-6; IL-8: 白细胞介素-8; IL-10: 白细胞介素-10; TNF-α: 肿瘤坏死因子-α。与T1时点比较, *P < 0.05; 与对照组比较, #P < 0.05。
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[1] ARBOUR K C, RIELY G J. Systemic therapy for locally advanced and metastatic non-small cell lung cancer: a review[J]. JAMA, 2019, 322(8): 764-774. doi: 10.1001/jama.2019.11058
[2] WILMORE D W, KEHLET H. Management of patients in fast track surgery[J]. BMJ, 2001, 322(7284): 473-476. doi: 10.1136/bmj.322.7284.473
[3] WILMORE D W. From cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients[J]. Ann Surg, 2002, 236(5): 643-648. doi: 10.1097/00000658-200211000-00015
[4] CERFOLIO R J, PICKENS A, BASS C, et al. Fast-tracking pulmonary resections[J]. J Thorac Cardiovasc Surg, 2001, 122(2): 318-324. doi: 10.1067/mtc.2001.114352
[5] 鲁全芝, 乔祖俊, 王刚, 等. 快速康复外科理念在腹腔镜结直肠癌围手术期的应用研究[J]. 中国肿瘤外科杂志, 2018, 10(1): 44-47. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLWK201801015.htm [6] 中国加速康复外科专家组. 中国加速康复外科围术期管理专家共识(2016版)[J]. 中华消化外科杂志, 2016, 15(6): 527-533. [7] YAMASHITA K, FUKUSAKI M, ANDO Y, et al. Preoperative administration of intravenous flurbiprofen axetil reduces postoperative pain for spinal fusion surgery[J]. J Anesth, 2006, 20(2): 92-95. doi: 10.1007/s00540-006-0389-6
[8] MAYES J, DAVISON E, PANAHI P, et al. An anatomical evaluation of the Serratus anterior plane block[J]. Anaesthesia, 2016, 71(9): 1064-1069. doi: 10.1111/anae.13549
[9] KUNHABDULLA N P, AGARWAL A, GAUR A, et al. Serratus anterior plane block for multiple rib fractures[J]. Pain Physician, 2014, 17(4): E553-E555. http://14.139.245.149:8080/xmlui/bitstream/1/9193/1/Serratus
[10] MADABUSHI R, TEWARI S, GAUTAM S K, et al. Serratus anterior plane block: a new analgesic technique for post-thoracotomy pain[J]. Pain Physician, 2015, 18(3): E421-E424. http://pdfs.semanticscholar.org/fc8b/58f3c262be5e415e5eeabda54d1f550f1aec.pdf
[11] LOHSER J, SLINGER P. Lung injury after one-lung ventilation: a review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung[J]. Anesth Analg, 2015, 121(2): 302-318. doi: 10.1213/ANE.0000000000000808
[12] 朱文刚. 加速康复外科对腹腔镜结直肠癌手术患者临床疗效及术后炎性细胞因子的影响[J]. 浙江中西医结合杂志, 2019, 29(11): 920-922. doi: 10.3969/j.issn.1005-4561.2019.11.017 [13] ŞENTÜRK M, SLINGER P, COHEN E. Intraoperative mechanical ventilation strategies for one-lung ventilation[J]. Best Pract Res Clin Anaesthesiol, 2015, 29(3): 357-369. doi: 10.1016/j.bpa.2015.08.001
[14] KREGENOW D A, RUBENFELD G D, HUDSON L D, et al. Hypercapnic acidosis and mortality in acute lung injury[J]. Crit Care Med, 2006, 34(1): 1-7. doi: 10.1097/01.CCM.0000194533.75481.03
[15] COSTELLO J, HIGGINS B, CONTRERAS M, et al. Hypercapnic acidosis attenuates shock and lung injury in early and prolonged systemic sepsis[J]. Crit Care Med, 2009, 37(3): 2412-2420. http://www.rtjournalonline.com/To%20put%20on%20website/Acid%20Base/Hypercapnia%20reduces%20inflammation%20in%20sepsis%20CCM%202009.pdf
[16] KOZIAN A, SCHILLING T, SCHVTZE H, et al. Ventilatory protective strategies during thoracic surgery: effects of alveolar recruitment maneuver and low-tidal volume ventilation on lung density distribution[J]. Anesthesiology, 2011, 114(5): 1025-1035. doi: 10.1097/ALN.0b013e3182164356
[17] CARVALHO A R, SPIETH P M, PELOSI P, et al. Ability of dynamic airway pressure curve profile and elastance for positive end-expiratory pressure titration[J]. Intensive Care Med, 2008, 34(12): 2291-2299. doi: 10.1007/s00134-008-1301-7
[18] CARVALHO A R, JANDRE F C, PINO A V, et al. Effects of descending positive end-expiratory pressure on lung mechanics and aeration in healthy anaesthetized piglets[J]. Crit Care, 2006, 10(4): R122. doi: 10.1186/cc5030
[19] TUSMAN G, BOHM S H, SUAREZ-SIPMANN F. Alveolar recruitment maneuvers for one-lung ventilation during thoracic anesthesia[J]. Curr Anesthesiol Rep, 2014, 4(2): 160-169. doi: 10.1007/s40140-014-0054-9
[20] 许新才, 田玉龙, 刘建捷, 等. 加速康复外科理念指导下行结直肠癌根治术的疗效评价[J]. 新疆医科大学学报, 2017, 40(3): 302-304, 307. https://www.cnki.com.cn/Article/CJFDTOTAL-XJYY201703009.htm [21] 陈学博, 高素洁, 费秉元, 等. 加速康复外科在胃结直肠癌微创手术中个体化实施的经验[J]. 腹腔镜外科杂志, 2017, 22(3): 177-179. https://www.cnki.com.cn/Article/CJFDTOTAL-FQJW201703006.htm [22] 杜广胜, 邱远, 彭科, 等. 加速康复外科理念结合腹腔镜手术治疗结直肠癌的临床效果观察[J]. 中国临床新医学, 2018, 11(6): 551-554. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLN201806010.htm [23] PICCIONI F, BERNASCONI F, TRAMONTANO G T A, et al. A systematic review of pulse pressure variation and stroke volume variation to predict fluid responsiveness during cardiac and thoracic surgery[J]. J Clin Monit Comput, 2017, 31(4): 677-684. doi: 10.1007/s10877-016-9898-5
[24] 刘航, 张跃天, 刘震, 等. 腹腔镜结直肠癌手术与开放性手术的疗效及安全性分析[J]. 实用癌症杂志, 2017, 32(3): 418-420. https://www.cnki.com.cn/Article/CJFDTOTAL-SYAZ201703022.htm [25] 王希, 黄建华, 罗浩元, 等. 加速康复外科对腹腔镜辅助结直肠癌根治术后患者免疫功能及近期结局的影响[J]. 腹腔镜外科杂志, 2016, 21(11): 837-841. https://www.cnki.com.cn/Article/CJFDTOTAL-FQJW201611010.htm -
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