快速康复对老年患者腹腔镜胃癌根治术后炎症反应及恢复的影响

发布时间：2018-05-21 11:23

本文选题：快速康复 + 腹腔镜　；参考：《郑州大学》2017年硕士论文

【摘要】：背景胃癌作为我国死亡率第三位的恶性肿瘤,一直是我国卫生、经济的一大负担。每年胃癌新发病例40余万,因胃癌死亡病例30余万[1],约占全国人群总癌死亡的15%和总死亡的3%[2]。当今我国已成为老龄化国家,老年人所占比例逐年上升,各种伴随的疾病及其负担也会接踵而至。老年患者的一般身体情况、生理状态及免疫功能相较于年轻人有所差异[3]。快速康复外科(fast-track surgery FTS)最先由丹麦医师提出,逐渐在国内外开展临床试验及研究,通过优化围手术期干预措施,减少对患者内环境的骚扰,加速术后恢复,是近年来研究的热点。腹腔镜技术自上世纪90年代应用于胃肠外科后,经过发展和完善,腹腔镜胃癌根治术已应用于胃癌患者,取得了不错的疗效。鉴于老年胃癌患者的差异性,快速康复外科理念不能照搬以往的经验,本文将以此展开研究和论述。目的将快速康复理念应用于行腹腔镜胃癌根治术的老年患者,探讨其术后近期疗效及对炎症反应的影响。方法自2014年10月至2016年10月,于郑州大学人民医院胃肠外科行腹腔镜胃癌根治术的老年患者92例,其中纳入快速康复路径患者46人(观察组),纳入常规治疗46例(对照组),回顾性分析其病例资料和生化检查结果,比较两组C反应蛋白(C reactive protein,CRP)、降钙素原(procalcitonin,PCT)、术后首次肛门排气时间、平均住院日等资料。运用SPSS 24.0进行统计学分析。结果两组患者CRP及PCT均较术前有所增高,对照组增高更明显(P0.05)。术后第1、4、7天观察组CRP为:17.19±11.14(mg/L)、13.81±4.17(mg/L)、6.98±1.98(mg/L),对照组CRP:24.91±17.88(mg/L)、19.91±7.79(mg/L)、8.70±1.84(mg/L)。术后第1、4、7天观察组PCT:1.59±1.29ng/mL、1.41±1.16ng/mL、0.59±0.40ng/mL,对照组PCT:2.30±1.20ng/mL、1.87±1.24ng/mL、0.71±0.42ng/mL。术后观察组首次通气时间50.38±10.83h,对照组为69.86±14.72h;平均住院时间观察组9.10±2.53d,对照组11.05±2.94d,观察组相较对照组,首次通气时间、平均住院日更短,差异均有统计学意义(P0.05)。观察组共有5例出现术后并发症,发生率10.87%。对照组共有7例出现并发症,发生率15.22%。两组患者并发症发生率,差异无统计学意义(P0.05)。结论对于行腹腔镜胃癌根治术的老年患者,围术期在快速康复理念指导下进行术后康复,可取得满意的临床效果。
[Abstract]:Background as the third leading malignant tumor in China, gastric cancer has been a great burden of health and economy in China. There are more than 400,000 new cases of gastric cancer every year, and more than 300,000 deaths due to gastric cancer, accounting for 15% of total cancer deaths and 3% of total deaths in China. Nowadays, China has become an aging country, the proportion of the elderly is increasing year by year, and various accompanying diseases and their burdens will follow. The general physical condition, physiological state and immune function of the elderly patients are different from those of the young people [3]. Fast-track surgery FTS was first put forward by Danish doctors. It is a hot topic in recent years to develop clinical trials and research at home and abroad. By optimizing perioperative intervention measures, reducing disturbance to patients' internal environment and accelerating postoperative recovery are the hot topics in recent years. Since its application in gastrointestinal surgery in 1990s, laparoscopic radical gastrectomy has been applied to patients with gastric cancer. In view of the difference of the elderly patients with gastric cancer, the concept of rapid rehabilitation surgery can not be copied from the previous experience. Objective to apply the idea of rapid rehabilitation to the elderly patients undergoing laparoscopic radical gastrectomy, and to explore the short-term effect of laparoscopic radical gastrectomy and its influence on inflammatory reaction. Methods from October 2014 to October 2016, 92 elderly patients underwent laparoscopic radical gastrectomy in the people's Hospital of Zhengzhou University. Among them, 46 patients were included in the rapid rehabilitation path (observation group) and 46 patients were included in routine therapy (control group). The case data and biochemical examination results were analyzed retrospectively. The data of C-reactive protein (CRP), procalcitonin (PCT), the first anal exhaust time after operation and the average hospitalization time were compared between the two groups. SPSS 24.0 was used for statistical analysis. Results the CRP and PCT in both groups were higher than those before operation, and the increase in control group was more obvious than that in the control group (P 0.05). The CRP of the observation group was 13.81 卤4.17 mg / L on the 1st day after operation, and that of the control group was 19.91 卤7.79 mg / L and 8.70 卤1.84 mg / L respectively, and that of the control group was 6.98 卤1.98 mg / L and 19.91 卤7.79 mg / L respectively. The PCT:1.59 卤1.29ng / mLL of the observation group was 1.41 卤1.16ng / mL 0.59 卤0.40ng / mL on the 7th day after operation, and that of the control group was PCT:2.30 卤1.20ng / mL0.87 卤1.24ng / mL 0.71 卤0.42ng / mL. The first ventilation time was 50.38 卤10.83 hours in the observation group and 69.86 卤14.72 hours in the control group, and the average hospitalization time was 9.10 卤2.53 days in the observation group and 11.05 卤2.94 days in the control group. In the observation group, there were 5 cases of postoperative complications (10.87%). There were 7 cases of complications in the control group, the incidence was 15.22%. There was no significant difference in the incidence of complications between the two groups (P 0.05). Conclusion for the elderly patients undergoing laparoscopic radical gastrectomy, the postoperative rehabilitation under the guidance of the idea of rapid rehabilitation in perioperative period can obtain satisfactory clinical results.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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