摘要
目的探讨加速康复外科理念（enhanced recovery after surgery，ERAS）对急腹症患者免疫功能及临床指标的影响。方法收集2016年3月到2017年3月因急腹症于郑州大学第一附属医院入院并行急诊手术的患者432例，按照随机数字法分为2组，加速康复外科手术方案治疗组（ERAS）和传统手术方案治疗组（conservative perioperative management，CPM）。于术前1h和术后第1、3、7天检测两组患者外周血清中CD4^＋，CD8^＋和CD4^＋／CD8^＋水平，并记录两组患者术后肠功能恢复时间、术后首次下床活动、首次进食时间、住院时间和并发症等临床指标。结果两组患者一般资料差异无统计学意义（P〉0．05）。两组患者术后第1天CD4^＋、CD4^＋／CD8^＋水平较术前降低（P〈0．05），CPM组降低更明显，两组术后第3、7天CD4^＋、CD4^＋／CD8^＋水平较术后第1天恢复，且ERAS组显著优于CPM组，差异有统计学意义（P〈0．05）。与CPM组比较，ERAS组术后肠功能恢复时间，术后首次下床活动、首次进食时间提前、住院时间缩短、术后WHO疼痛分级降低，并发症的发生率降低（P〈0．05）。结论加速康复外科理念可减轻急腹症患者术后的免疫抑制，保护机体免疫功能，加速术后恢复，具有临床推广价值。
Objective To evaluate the effect of enhanced recovery after surgery （ERAS） on immune function and clinical signs in patients with acute abdomen. Methods From March 2016 to March 2017, patients with acute abdominal admitted in the Emergency Care Center of the First Affiliated Hospital of Zhengzhou University were collected and randomized into ERAS group and conventional peri-operative management group （CPM group）. In addition to clinical signs （the time of bowel movemtn recovery, the time of first postoperative ingestion and ambulation, hospital stay, complication rates）, the celluar immunity （ CD4^＋, CD8 ^＋ , CD4^＋/CD8^ ＋ ） were determined during peri-operation period. Results A cohort of 240 patients were in ERAS group and 192 patients in CPM group. There was no significant difference in general condition between the two groups （ P 〉 0.05 ）. On the first day after operation, the levels of CD4^＋ , CD4^＋ / CD8^＋ decreased in both groups （ P 〈 0. 05 ） , but the CPM group had lower levels of CD4^ ＋ , CD4^＋/CD8^＋ than the ERAS groups. On the 3rd and 7th days after surgery, the ERAS groups had higer levels of CD4^＋ , CD4^＋/CD8^＋ than the CPM groups, （the levels of CD4^＋ , CD4^＋/CD8^＋ recovery on the 3rd and 7th day after operation, and the ERAS group was significantly better than the CPM group） （P 〈 0. 05 ）. Compared with CPM group, the recovery of bowel movement appeared earlier after operation in ERAS group with sooner resuming ingestion and ambulation after operation, shorter hospital stay, and lower WHO pain rating scale and complication rates （ P 〈 O. 05 ）. Conclusions ERAS for patients with acute abdomen can alleviate postoperative suppression of immunity, preserving immune function intact and accelerating postoperative rehabilitation.
作者
李亚楠
刘兰萍
朱长举
王万鹏
张雪娟
刘海燕
Li Yanan Liu Lanping Zhu Changju Wang Wanpeng Zhang Xuejuan Liu Haiyan(Department of Emergency Surgery, Emergency Care Center, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Chin)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2017年第11期1319-1323,共5页
Chinese Journal of Emergency Medicine
关键词
加速康复外科
急腹症
外科手术
细胞免疫
Enhanced recovery after surgery
Acute abdomen
Operation
Cellular immunity
