摘要
目的分析快速康复外科理念在腹腔镜胆囊切除术中的应用效果。方法将我院收治的122例行腹腔镜胆囊切除术患者随机分为观察组和对照组,各61例。观察组给予快速康复外科理念指导下的手术及围术期干预治疗,对照组则给予常规腹腔镜手术及围术期干预治疗。比较两组的干预效果。结果术后24 h,两组的IL-6、CRP及肾上腺素水平均升高,但观察组显著低于对照组(P<0.05)。术后24 h,两组CD4^+水平和CD4^+/CD8^+均显著降低,CD8^+水平均显著升高,且观察组显著优于对照组(P<0.05);术后72 h,两组CD4^+水平和CD4^+/CD8^+均较术后24 h显著升高,CD8^+水平较术后24 h显著降低(P<0.05),但观察组的CD4^+、CD8^+水平及CD4^+/CD8^+与术前比较,差异不显著(P>0.05),对照组的CD4^+水平和CD4^+/CD8^+均低于术前,CD8^+水平高于术前(P<0.05)。观察组的术后进食时间、术后离床时间及住院时间均显著短于对照组(P<0.05)。术前,观察组的SAS及SDS评分均显著低于入院时和对照组(P<0.05);术后36 h,两组SAS及SDS评分均显著低于术前,且观察组低于对照组(P<0.05)。结论在快速康复外科理念指导下实施腹腔镜胆囊切除术及围术期干预,能够显著降低手术对患者造成的生理应激反应及免疫抑制,同时能提高康复效率及改善患者的负性心理,值得在腹腔镜微创手术中进一步研究应用。
Objective To analyze the application effect of rapid rehabilitation surgery concept in laparoscopic cholecystectomy.Methods A total of 122 cases of patients with laparoscopic cholecystectomy were randomly divided into observation group and control group,with 61 cases in each group.The observation group was given surgery and perioperative intervention under the guidance of rapid rehabilitation surgery concept,while the control group was given routine laparoscopic surgery and perioperative intervention.The intervention effects of the two groups were compared.Results At 24 hours after operation,the levels of IL-6,CRP and adrenaline in both groups increased,but those in the observation group were significantly lower than the control group (P<0.05).At 24 hours after operation,the levels of CD4^+ and CD4^+/CD8^+ in both groups significantly decreased,and the level of CD8+ significantly increased,and those of the observation group were significantly better than the control group (P<0.05).At 72 hours after operation,the level of CD4^+ and CD4^+/CD8^+ in the two groups were significantly higher than those at 24 hours after operation,and the level of CD8^+ were significantly lower than those at 24 hours after operation (P<0.05),but the levels of CD4^+ and CD8^+,CD4^+/CD8^+ in the observation group were not significantly different from those before operation (P>0.05),while the level of CD4^+ and CD4^+/CD8^+ in the control group were lower than those before operation,and the level of CD8^+ was higher than that before operation (P<0.05).The time of eating,leaving bed and hospitalization in the observation group were significantly shorter than those in the control group (P<0.05).Before operation,the scores of SAS and SDS in the observation group were significantly lower than those in the control group and at admission (P<0.05);at 36 hours after operation,the scores of SAS and SDS in both groups were significantly lower than those before operation,and those in the observation group were lower than those in the control group (P<0.05).Conclusion The implementation of laparoscopic cholecystectomy and perioperative intervention under the guidance of rapid rehabilitation surgery concept can significantly reduce the physiological stress response and immune suppression caused by surgery,improve the rehabilitation efficiency and the negative psychology of patients,which is worthy of further research and application in laparoscopic minimally invasive surgery.
作者
刘磊
LIU Lei(No.2 Surgery Department,the Hospital of Fuping County,Weinan 711700,China)
出处
《临床医学研究与实践》
2019年第2期64-65,79,共3页
Clinical Research and Practice
关键词
快速康复外科理念
腹腔镜胆囊切除术
应激反应
免疫抑制
rapid rehabilitation surgery concept
laparoscopic cholecystectomy
stress response
immunosuppression
