加速康复外科对合并有糖尿病的结直肠癌患者术后炎症反应与营养代谢的影响(1)
摘要：目的 通過观察ERAS对合并有糖尿病的结直肠癌患者术后炎症反应与营养代谢的影响，明确ERAS对糖尿病人群的安全性与有效性。方法 本研究为随机对照研究，选取2017年1月1日～2018年5月31日入住青岛大学附属医院胃肠外科的80例患者，随机分为对照组和试验组，每组40例。术前均严格控制血糖稳定后行结直肠癌根治术。试验组应用ERAS理念指导患者围手术期处理，对照组进行常规处理，观察两组患者术后基本恢复情况(排气时间、住院时间、住院费用、并发症、胰岛素抵抗)，同时比较两组患者炎症反应指标肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、C反应蛋白(CRP)与营养代谢指标白蛋白(ALB)、前白蛋白(PA)、总蛋白(TP)。结果 本研究有75例患者最终完成试验(试验组38例，对照组37例)，试验组术后排气时间为(52.84±9.79)h，短于较对照组的(66.14±15.50)h，试验组出院时间为(6.08±1.40)d，短于对照组的(7.83±1.48)d，差异均有统计学意义(P<0.05);两组患者术后并发症无明显差异(P>0.05)，试验组术后炎症反应较对照组轻，营养状况较对照组恢复更快，差异有统计学意义(P<0.05)。两组患者术前胰岛素抵抗无明显差异，术后第1、3天试验组较对照组明显偏低，差异均具有统计学意义(P<0.05)，术后第7天比较差异无统计学意义(P>0.05)。结论 ERAS可加快胃肠道功能的恢复，缩短住院日，降低住院费用，同时能够减轻患者术后炎症反应，改善患者术后营养状况，加速患者康复。对于合并有糖尿病的结直肠癌病人安全、有效，证明ERAS同样适用于合并有糖尿病的结直肠癌人群。
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关键词：加速康复外科;结直肠癌;糖尿病;炎症反应;营养状况
中图分类号：R587.1;R735.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.07.021
文章编号：1006-1959(2019)07-0067-06
Abstract：Objective By observing the effect of ERAS on postoperative inflammatory response and nutrient metabolism in patients with colorectal cancer with diabetes， the safety and efficacy of ERAS in diabetic patients were clarified. Methods This study was a randomized controlled trial of 80 patients admitted to the Department of Gastrointestinal Surgery， Affiliated Hospital of Qingdao University from January 1， 2017 to May 31， 2018. They were randomly divided into the control group and the experimental group， with 40 cases in each group. Colorectal cancer radical surgery was performed after strict control of blood glucose stability before surgery. The experimental group used the ERAS concept to guide the perioperative management of the patients， and the control group performed routine treatment to observe the basic recovery after operation (exhaust time， hospitalization time， hospitalization expenses， complications， insulin resistance)， and compare the two groups of patients. Inflammatory response indicators tumor necrosis factor alpha (TNF-α)， interleukin-6 (IL-6)， C-reactive protein (CRP) and nutritional metabolic indicators albumin (ALB)， prealbumin (PA)， total protein (TP). Results In this study， 75 patients completed the trial (38 in the experimental group and 37 in the control group). The postoperative exhaust time was (52.84±9.79) h， which was shorter than that of the control group (66.14±15.50) h. The discharge time of the group was (6.08±1.40)d， which was shorter than that of the control group (7.83±1.48)d，the difference was statistically significant (P<0.05). There was no significant difference in postoperative complications between the two groups (P>0.05). The inflammatory response of the experimental group was lighter than that of the control group， and the nutritional status recovered faster than the control group，the difference was statistically significant (P<0.05). There was no significant difference in preoperative insulin resistance between the two groups. On the 1st and 3rd day after operation， the experimental group was significantly lower than the control group，the difference was statistically significant (P<0.05). There was no significant difference on the 7th day after operation(P>0.05). Conclusion ERAS can accelerate the recovery of gastrointestinal function， shorten the hospitalization day， reduce the hospitalization cost， and at the same time reduce the postoperative inflammatory response， improve the postoperative nutritional status of patients， and accelerate the recovery of patients. For patients with colorectal cancer with diabetes， it is safe and effective， and it is proved that ERAS is also suitable for colorectal cancer patients with diabetes., 百拇医药(李大略 赵资文 刘兆礼)
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关键词：加速康复外科;结直肠癌;糖尿病;炎症反应;营养状况
中图分类号：R587.1;R735.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.07.021
文章编号：1006-1959(2019)07-0067-06
Abstract：Objective By observing the effect of ERAS on postoperative inflammatory response and nutrient metabolism in patients with colorectal cancer with diabetes， the safety and efficacy of ERAS in diabetic patients were clarified. Methods This study was a randomized controlled trial of 80 patients admitted to the Department of Gastrointestinal Surgery， Affiliated Hospital of Qingdao University from January 1， 2017 to May 31， 2018. They were randomly divided into the control group and the experimental group， with 40 cases in each group. Colorectal cancer radical surgery was performed after strict control of blood glucose stability before surgery. The experimental group used the ERAS concept to guide the perioperative management of the patients， and the control group performed routine treatment to observe the basic recovery after operation (exhaust time， hospitalization time， hospitalization expenses， complications， insulin resistance)， and compare the two groups of patients. Inflammatory response indicators tumor necrosis factor alpha (TNF-α)， interleukin-6 (IL-6)， C-reactive protein (CRP) and nutritional metabolic indicators albumin (ALB)， prealbumin (PA)， total protein (TP). Results In this study， 75 patients completed the trial (38 in the experimental group and 37 in the control group). The postoperative exhaust time was (52.84±9.79) h， which was shorter than that of the control group (66.14±15.50) h. The discharge time of the group was (6.08±1.40)d， which was shorter than that of the control group (7.83±1.48)d，the difference was statistically significant (P<0.05). There was no significant difference in postoperative complications between the two groups (P>0.05). The inflammatory response of the experimental group was lighter than that of the control group， and the nutritional status recovered faster than the control group，the difference was statistically significant (P<0.05). There was no significant difference in preoperative insulin resistance between the two groups. On the 1st and 3rd day after operation， the experimental group was significantly lower than the control group，the difference was statistically significant (P<0.05). There was no significant difference on the 7th day after operation(P>0.05). Conclusion ERAS can accelerate the recovery of gastrointestinal function， shorten the hospitalization day， reduce the hospitalization cost， and at the same time reduce the postoperative inflammatory response， improve the postoperative nutritional status of patients， and accelerate the recovery of patients. For patients with colorectal cancer with diabetes， it is safe and effective， and it is proved that ERAS is also suitable for colorectal cancer patients with diabetes., 百拇医药(李大略 赵资文 刘兆礼)