加速康复外科对远端胃癌根治术后患者炎症反应和免疫功能的影响(1)
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2010年2月1日
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【摘要】目的:该研究应用加速康复外科新理念,观察对远端胃癌根治术后炎症反应和免疫功能的影响。方法:将46例远端胃癌手术病人随机分为两组,研究组(FTS组)病人应用加速康复外科治疗,对照组病人应用传统围手术期处理方法。观察两组病人术后首次肠道通气时间、术后住院时间和并发症,并于术前1天、术后第1天和第3天检测病人外周血清中IL-6、CRP、CD3、CD4、CD8和CD4/CD8比值。结果:FTS组与对照组比,术后住院时间显著缩短(P<0.05);术后首次排气时间显著提前(P<0.05);而术后并发症两者无显著差异。FTS组与对照组比,术后第1、3天外周血中CRP和IL-6浓度均有显著下降(P<0. 05);CD4/CD8比值均有显著增加(P<0.05)。结论:应用加速康复外科能缓解远端胃癌手术病人的术后炎症反应,保护术后细胞免疫功能,促进病人快速康复。
【关键词】加速康复外科;胃癌;细胞免疫;炎症反应
【中图分类号】R459.3 【文献标识码】B 【文章编号】1008-6455(2010)08-0124-02
The impact of fast track surgery on host cell-mediated immunity and inflammatory responses in patients after gastrectomy for gastric cancer
Han Shuling Qin Jiaruo
【Abstract】Objective:The aim of this study was to evaluate the impact of fast track surgery on host cell-mediated immunology and inflammatory responses in patients after gastrectomy for gastric cancer.Methods:forty-six gastric cancer patients were prospectively divided into fast track surgery (FTS)group (n=23) and conventional perioperative care group (n=23). In addition to clinical parameters (recovery of gastrointestinal function,postoperative length of stay andcomplication rates),the parameters of perioperative cell-mediated immunology function,and the serum level changes of CRP and IL-6 were determined. Results:FTS group was associated with a significantly shorter postoperative hospital stay compared with conventional care group (P<0.05). Serum concentration of CRP and IL-6 in FTS group were lower(P<0.05) than in the conventional care group on postoperative day(POD)1 and POD 3(P<0.05).CD4/CD8 ratio in FTS group were higher (P<0.05) than in the conventional care group on postoperative day (POD)1 and POD 3(P<0. 05).Conclusion:Fast track surgery for gastric cancer patients can preserve cell-mediated immunity and control inflammatory responses when compared with conventional postoperative care.
【Key words】Fast track surgery;Gastric cancer;Cell-mediated immunity;Inflammatory response
加速康复外科(fast tract surgery,FTS)是指在围手术期应用有循证医学证据的优化处理措施,减缓手术病人生理和心理的创伤应激,达到病人的快速康复。主要内容包括加强病人术前教育、术前不长时间禁食、不常规进行肠道准备、术前口服糖类饮品进行代谢准备、使用硬膜外联合全身麻醉、注意术中保温和控制性输液、不常规放置鼻胃管和腹腔引流管、术后早期进食和下床活动等 ......
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