比较腹腔镜结肠癌手术加速康复过程中两种液体治疗措施的临床转归

发布时间：2018-11-13 15:53

【摘要】：目的:比较腹腔镜结肠癌手术加速康复治疗过程中应用不同液体治疗措施对患者术后液体容量指标、炎症反应、并发症、术后住院时间及住院费用等方面的影响。方法:前瞻性地纳入吉林大学白求恩第一医院2015年11月至2016年12月明确诊断为结肠癌并拟行择期腹腔镜手术的患者,随机分为实验组和对照组。实验组患者术后按1.0 ml/(kg·h)进行静脉液体计算以限制静脉补液(h仅代表拟补液时间),鼓励患者术后早期进食水,当经口液体摄入量大于1500ml/24h时停止静脉补液;对照组术后严格禁食并按照2.0 ml/(kg·h)进行开放性静脉补液直至肠道功能完全恢复。观察两组患者术后血容量变化指标[心率、平均动脉压、血氧饱和度、下腔静脉宽度与体表面积比值(VCD)、腹腔内压(IAP)、尿比重、B型钠尿肽(BNP)等]及炎症指标变化[C-反应蛋白(CRP)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)],比较两组患者肠道功能恢复时间、并发症的发生率、术后住院时间、住院费用等差异。结果:研究最终共纳入患者146例,其中实验组69例,对照组77例。两组患者术前血容量指标及炎症指标差异均无统计学意义(P0.05)。实验组患者术后心率、平均动脉压、血氧饱和度与对照组无统计学差异(P0.05),但术后VCD、IAP、尿比重、BNP、CRP、IL-6、TNF-α等指标均有显著差异(P0.05)。与对照组相比,实验组患者术后肠道功能恢复时间[(2.3±1.0)d vs.(2.9±1.3)d,P=0.025]、术后住院时间[(6.7±2.0)d vs.(8.8±2.6)d,P=0.038]、住院费用[(52749±9644)元vs.(59942±11217)元,P=0.027]、术后并发症发生率均显著低于对照组(P0.05)。结论:在结肠癌患者加速康复流程中,术后静脉液体量按照1.0 ml/(kg·h)进行计算并结合早期经口补液的方案具有一定的安全性,可应用于临床。与传统补液方案相比,该补液方案能够减轻容量负荷、降低围手术期应激、减轻炎症反应;能够有效地减少并发症、缩短住院时间,节省住院费用。
[Abstract]:Objective: to compare the effects of different liquid therapy measures on postoperative fluid volume, inflammatory reaction, complications, postoperative hospitalization time and hospitalization cost in patients with laparoscopic colon cancer. Methods: the patients diagnosed with colon cancer from November 2015 to December 2016 were prospectively included in Bethune first Hospital of Jilin University and were randomly divided into experimental group and control group. In the experimental group, intravenous fluid was calculated at 1. 0 ml/ (kg h) after operation to limit the intravenous fluid resuscitation (h is only the time of the intended rehydration), and the patients were encouraged to consume water early after the operation. The intravenous fluid rehydration was stopped when the oral fluid intake was greater than 1500ml/24h. The control group fasted strictly after operation and performed open venous rehydration according to 2.0 ml/ (kg h) until the intestinal function was completely recovered. The changes of blood volume [heart rate, mean arterial pressure, blood oxygen saturation, ratio of inferior vena cava width to body surface area] (VCD), intraperitoneal pressure (IAP),) urine specific gravity were observed in both groups. B-type natriuretic peptide (BNP) et al., and the changes of inflammatory indexes [C- reactive protein (CRP), interleukin-10 (IL-10), tumor necrosis factor- 伪 (TNF- 伪)]. The recovery time of intestinal function and the incidence of complications were compared between the two groups. Postoperative hospital stay, hospital expenses and other differences. Results: a total of 146 patients were included in the study, 69 in the experimental group and 77 in the control group. There was no significant difference in preoperative blood volume and inflammation between the two groups (P0.05). There was no significant difference in heart rate, mean arterial pressure and oxygen saturation between experimental group and control group (P0.05), but there was significant difference in urine specific gravity of VCD,IAP, and BNP,CRP,IL-6,TNF- 伪 after operation (P0.05). Compared with the control group, the postoperative recovery time of intestinal function in the experimental group was (2.3 卤1.0) d vs. (卤2.9 卤1.3) dP0.025, and the postoperative hospitalization time was (6.7 卤2.0) d vs. (, 8.8 卤2.6) days. The cost of hospitalization [(52749 卤9644) yuan vs. (59942 卤11217) yuan, P < 0.027] was significantly lower than that of the control group (P0.05). Conclusion: in the process of accelerated rehabilitation for colon cancer patients, the postoperative intravenous fluid volume was calculated according to 1.0 ml/ (kg h) and combined with the early oral fluid replacement regimen, which can be used in clinical practice. Compared with the traditional fluid rehydration scheme, the solution can reduce volume load, reduce perioperative stress and inflammatory reaction, reduce complications, shorten hospitalization time and save hospital expenses.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.35

【相似文献】