目的 探讨加速康复外科(ERAS)在胃癌根治术中的临床价值.方法 选取2011年4月至2013年6月青岛大学附属医院行胃癌根治术的140例患者进行前瞻性研究,采用随机、双盲对照法,通过随机数字表法将入组患者分为ERAS组(围术期采用ERAS处理方案)和对照组(围术期采用传统处理方案).观察患者炎症指标、营养状况指标变化以及术后恢复情况.ERAS组患者于出院后24 h内进行第1次电话随访,出院2周进行门诊随访,直至术后30 d结束.对照组出院后3周门诊常规复查.正态分布的计量资料采用x±s表示,组间比较采用独立样本t检验;各指标趋势比较采用重复测量方差分析.计数资料采用,检验或Fisher确切概率法.结果 筛选出符合研究条件的患者80例,ERAS组和对照组各40例.两组患者血清TP、Alb、前白蛋白、TNF-α、IL-6、C反应蛋白、静息能量消耗、血糖、胰岛素、胰岛素抵抗指数术后1、3、5d在一定趋势内变化,ERAS组术后1d分别为(61±5)g/L、(34±3)g/L、(160±18) g/L、(12.3±2.3) mmol/L、(101±34) ng/L、(43±11)g/L、(1 336±105) kal/d、(7.6±0.8) mmol/L、(16.8±3.5) mU/L、5.7±1.3;对照组分别为(58 ±4)g/L、(31±4)g/L、(147±18) g/L、(15.3±2.2)mmol/L、(122±37) ng/L、(56±27) g/L、(1 450±164) kal/d、(9.3±1.4) mmol/L、(30.5±6.8)mU/L、12.5±3.2,两组比较,差异有统计学意义(F=31.63,8.03,67.36,147.04,9.63,6.84,16.10,54.85,104.51,139.47,P＜0.05).ERAS组患者术后发热时间、肛门排气时间、住院时间和住院费用、疼痛评分、生命质量评分分别为(2.9 ±0.9)d、(2.9 ±0.6)d、(7.6±2.1)d、(28 495±4 722)元、(1.4±1.0)分、(15.4±0.9)分;对照组分别为(3.8 ±0.6)d、(3.5 ±0.7)d、(8.9 ±2.6)d、(35 318 ±7 610)元、(2.4±1.1)分、(14.4±1.2)分,两组比较,差异有统计学意义(t =-0.91,-3.66,-2.85,-4.82,-4.20,3.92,P＜0.05).ERAS组患者发生呼吸道相关并发症2例,再手术患者1例,术后30 d再入院1例;对照组则分别为3例、1例、2例,两组比较,差异无统计学意义(P＞0.05).结论 ERAS应用于胃癌根治术患者的围术期安全可行.它能减轻手术应激,缩短住院时间,改善患者生命质量,且不增加术后并发症,这可能与减少患者胰岛素抵抗、降低静息能量代谢有关.临床试验注册在中国临床试验注册中心注册,注册号为ChiCTR-TRC-10001611.
目的 探討加速康複外科(ERAS)在胃癌根治術中的臨床價值.方法 選取2011年4月至2013年6月青島大學附屬醫院行胃癌根治術的140例患者進行前瞻性研究,採用隨機、雙盲對照法,通過隨機數字錶法將入組患者分為ERAS組(圍術期採用ERAS處理方案)和對照組(圍術期採用傳統處理方案).觀察患者炎癥指標、營養狀況指標變化以及術後恢複情況.ERAS組患者于齣院後24 h內進行第1次電話隨訪,齣院2週進行門診隨訪,直至術後30 d結束.對照組齣院後3週門診常規複查.正態分佈的計量資料採用x±s錶示,組間比較採用獨立樣本t檢驗;各指標趨勢比較採用重複測量方差分析.計數資料採用,檢驗或Fisher確切概率法.結果 篩選齣符閤研究條件的患者80例,ERAS組和對照組各40例.兩組患者血清TP、Alb、前白蛋白、TNF-α、IL-6、C反應蛋白、靜息能量消耗、血糖、胰島素、胰島素牴抗指數術後1、3、5d在一定趨勢內變化,ERAS組術後1d分彆為(61±5)g/L、(34±3)g/L、(160±18) g/L、(12.3±2.3) mmol/L、(101±34) ng/L、(43±11)g/L、(1 336±105) kal/d、(7.6±0.8) mmol/L、(16.8±3.5) mU/L、5.7±1.3;對照組分彆為(58 ±4)g/L、(31±4)g/L、(147±18) g/L、(15.3±2.2)mmol/L、(122±37) ng/L、(56±27) g/L、(1 450±164) kal/d、(9.3±1.4) mmol/L、(30.5±6.8)mU/L、12.5±3.2,兩組比較,差異有統計學意義(F=31.63,8.03,67.36,147.04,9.63,6.84,16.10,54.85,104.51,139.47,P＜0.05).ERAS組患者術後髮熱時間、肛門排氣時間、住院時間和住院費用、疼痛評分、生命質量評分分彆為(2.9 ±0.9)d、(2.9 ±0.6)d、(7.6±2.1)d、(28 495±4 722)元、(1.4±1.0)分、(15.4±0.9)分;對照組分彆為(3.8 ±0.6)d、(3.5 ±0.7)d、(8.9 ±2.6)d、(35 318 ±7 610)元、(2.4±1.1)分、(14.4±1.2)分,兩組比較,差異有統計學意義(t =-0.91,-3.66,-2.85,-4.82,-4.20,3.92,P＜0.05).ERAS組患者髮生呼吸道相關併髮癥2例,再手術患者1例,術後30 d再入院1例;對照組則分彆為3例、1例、2例,兩組比較,差異無統計學意義(P＞0.05).結論 ERAS應用于胃癌根治術患者的圍術期安全可行.它能減輕手術應激,縮短住院時間,改善患者生命質量,且不增加術後併髮癥,這可能與減少患者胰島素牴抗、降低靜息能量代謝有關.臨床試驗註冊在中國臨床試驗註冊中心註冊,註冊號為ChiCTR-TRC-10001611.
목적 탐토가속강복외과(ERAS)재위암근치술중적림상개치.방법 선취2011년4월지2013년6월청도대학부속의원행위암근치술적140례환자진행전첨성연구,채용수궤、쌍맹대조법,통과수궤수자표법장입조환자분위ERAS조(위술기채용ERAS처리방안)화대조조(위술기채용전통처리방안).관찰환자염증지표、영양상황지표변화이급술후회복정황.ERAS조환자우출원후24 h내진행제1차전화수방,출원2주진행문진수방,직지술후30 d결속.대조조출원후3주문진상규복사.정태분포적계량자료채용x±s표시,조간비교채용독립양본t검험;각지표추세비교채용중복측량방차분석.계수자료채용,검험혹Fisher학절개솔법.결과 사선출부합연구조건적환자80례,ERAS조화대조조각40례.량조환자혈청TP、Alb、전백단백、TNF-α、IL-6、C반응단백、정식능량소모、혈당、이도소、이도소저항지수술후1、3、5d재일정추세내변화,ERAS조술후1d분별위(61±5)g/L、(34±3)g/L、(160±18) g/L、(12.3±2.3) mmol/L、(101±34) ng/L、(43±11)g/L、(1 336±105) kal/d、(7.6±0.8) mmol/L、(16.8±3.5) mU/L、5.7±1.3;대조조분별위(58 ±4)g/L、(31±4)g/L、(147±18) g/L、(15.3±2.2)mmol/L、(122±37) ng/L、(56±27) g/L、(1 450±164) kal/d、(9.3±1.4) mmol/L、(30.5±6.8)mU/L、12.5±3.2,량조비교,차이유통계학의의(F=31.63,8.03,67.36,147.04,9.63,6.84,16.10,54.85,104.51,139.47,P＜0.05).ERAS조환자술후발열시간、항문배기시간、주원시간화주원비용、동통평분、생명질량평분분별위(2.9 ±0.9)d、(2.9 ±0.6)d、(7.6±2.1)d、(28 495±4 722)원、(1.4±1.0)분、(15.4±0.9)분;대조조분별위(3.8 ±0.6)d、(3.5 ±0.7)d、(8.9 ±2.6)d、(35 318 ±7 610)원、(2.4±1.1)분、(14.4±1.2)분,량조비교,차이유통계학의의(t =-0.91,-3.66,-2.85,-4.82,-4.20,3.92,P＜0.05).ERAS조환자발생호흡도상관병발증2례,재수술환자1례,술후30 d재입원1례;대조조칙분별위3례、1례、2례,량조비교,차이무통계학의의(P＞0.05).결론 ERAS응용우위암근치술환자적위술기안전가행.타능감경수술응격,축단주원시간,개선환자생명질량,차불증가술후병발증,저가능여감소환자이도소저항、강저정식능량대사유관.림상시험주책재중국림상시험주책중심주책,주책호위ChiCTR-TRC-10001611.
Objective To investigate the clinical efficacy of enhanced recovery after surgery (ERAS) in the radical gastrectomy for gastric cancer.Methods The clinical data of 140 patients undergoing radical gastrectomy for gastric cancer at the Affiliated Hospital of Qingdao University from April 2011 to June 2013 were prospectively analyzed.A double-blind,randomized,controlled study was performed in the 140 patients,and all of them were divided into the ERAS group (patients undergoing perioperative management according to enhanced recovery rehabilitation program) and the control group (patients undergoing perioperative management) based on a random numble table.The inflammatory markers,nutritional index and postoperative recovery of patients were observed.Patients of the ERAS group were followed up by telephone interview within the first 24 hours after discharge,and by outpatient examination since the second week after discharge.The follow-up was ended at postoperative day 30.Patients of the control group were reexamined at the third week after discharge.The measurement data with normal distribution was presented as x ± s.The comparison between groups was evaluated with an independent sample t test.The trend analyses for variables were done using repeated measures ANOVA.The count data were analyzed using the chi-square test or Fisher exact probability.Results Eighty patients were screened for eligibility,and were allocated into the ERAS group (40 patients) and the control group (40 patients).The total protein in serum (TP),albumin (Alb),prealbumin,TNF-α,IL-6,c-reactive protein,resting energy expenditure (REE),glycemic index,insulin index and Insulin resistance index in the 2 groups showed a range of variations at postoperative day 1,3,and 5,and these were (61 ±5)g/L,(34 ±3)g/L,(160 ± 18)g/L,(12.3 ±2.3)mmol/L,(101 ±34)ng/L,(43 ± 11)g/L,(1 336 ± 105)kal/d,(7.6 ±0.8)mmol/L,(16.8 ±3.5)mU/L and 5.7 ±1.3 in the ERAS group at postoperative day 1,and (58 ± 4) g/L,(31 ± 4) g/L,(147 ± 18) g/L,(15.3 ± 2.2) mmol/L,(122 ±37)ng/L,(56 ±27) g/L,(1 450 ± 164)kal/d,(9.3 ± 1.4) mmol/L,(30.5 ±6.8) mU/L and 12.5 ±3.2 in the control group,respectively,showing a significant difference between the 2 groups (F =31.63,8.03,67.36,147.04,9.63,6.84,16.10,54.85,104.51,139.47,P ＜0.05).The duration of fever,time to flatus,duration of hospital stay,hospital expenses,numeric rating scale and quality of life (QOL) were (2.9 ±0.9) days,(2.9 ± 0.6) days,(7.6 ± 2.1) days,(28 495 ± 4 722) yuan,1.4 ± 1.0 and 15.4 ± 0.9 in the ERAS group after operation,and (3.8 ±0.6)days,(3.5 ±0.7)days,(8.9 ±2.6)days,(35 318 ±7 610)yuan,2.4 ± 1.1 and 14.4 ± 1.2 in the control group,respectively,with a significant difference between the 2 groups (t =-0.91,-3.66,-2.85,-4.82,-4.20,3.92,P ＜0.05).Two patients were complicated with respiratory diseases,1 patient received reoperation and 1 was readmitted to the hospital at postoperative day 30 in the ERAS group.Three patients had respiratory diseases,1 received reoperation and 2 were readmitted to the hospital at postoperative day 30 in the control group,with no significant difference between the 2 groups (P ＞ 0.05).Conclusions ERAS is safe and feasible for the perioperative treatment of patients with gastric cancer,meanwhile it could reduce the surgical stress,shorten the duration of hospital stay and improve QOL and postoperative complications,ERAS might take effects by reducing insulin resistance and decreasing REE.Registry This study was registered with the Chinese Clinical Trial Registry with the registry number of ChiCTR-TRC-10001611.
