| 摘要: |
| 目的：观察加速康复外科（ERAS）对腹腔镜胆总管切开取石患者炎症和应激反应的影响。方法：选择 2015 年 1 月—2018 年 12 月在我院诊治胆总管结石的患者 90 例，按照随机数字的方法将患者分为观察组和对照组，每组各 45 例。 两组均行腹腔镜胆总管切开取石 +T 管引流（合并胆囊结石行腹腔镜胆囊切除术），对照组予以传统的围手术期治疗，观察组予以 ERAS 理念下的围手术期治疗。观察两组术后临床指标变化，比较两组术后第 1 天和术后第 4 天血清白细胞（WBC）、 谷丙转氨酶（ALT）、直接胆红素（DBil）、白蛋白、前白蛋白、转铁蛋白、高敏 C 反应蛋白（hs-CRP）、白介素（IL）-6、 肿瘤坏死因子（TNF）-α、肾素（PRA）、血管紧张素 -2（ANG-2）和醛固酮（ALD）水平。结果：观察组的首次下床时 间、肛门排气时间、开始进食时间、输液时间、夹闭 T 管时间和住院时间明显短于对照组（P<0.01）。术后第 1 天两组患 者血清 WBC、ALT、DBil、白蛋白、前白蛋白、转铁蛋白、hs-CRP、IL-6 和 TNF-α 水平比较差异无统计学意义（P>0.05）， 术后两组第 4 天的 WBC、ALT、DBil、hs-CRP、IL-6、TNF-α、PRA、ANG-2 和 ALD 均较术后第 1 天明显降低（P<0.01）， 两组术后第 4 天的白蛋白，前白蛋白和转铁蛋白水平均较术后第 1 天明显升高（P<0.01），而术后第 4 天相应指标观察组明 显低或者高于对照组（P<0.01）。结论：ERAS 可促进腹腔镜胆总管切开取石术后患者康复，促进肝脏功能损伤的恢复，对机体的炎症和应激具有缓解作用。 |
| 关键词: 加速康复外科 腹腔镜 胆总管结石 炎症 应激反应 |
| DOI：10.3969/j.issn.1007-6948.2019.06.013 |
|
| 基金项目:台州市黄岩区科技计划项目（2015050-7） |
|
| Impact of Enhanced Recovery after Surgery on Inflammation and Stress Response of Patients Undergoing Laparoscopic Common Bile Duct Exploration T-tube Choledochotomy |
| LIAO Nan-sheng,ZHANG Yan,WANG Rong-guo |
| Department of General Surgery and Gastroenterology, Taizhou First People' s Hospital/ Huangyan Hospital Affifiliated to Wenzhou Medical University, Taizhou (318020), China |
| Abstract: |
| Objective To observe the impact of enhanced recovery after surgery (ERAS) on inflammation and stress response in patients undergoing laparoscopic common bile duct exploration T-tube choledochotomy. Methods Totally 90 patients with choledocholithiasis in our hospital, from January 2015 to December 2018, were divided into observation group and control group according to random number method, with 45 cases in each group. Abdominal choledocholithotomy and T-tube drainage (laparoscopic cholecystectomy with gallstones) were performed in two groups, the patients in control group were treated with concept of traditional perioperative period, and the patients in observation group were performed under the concept of ERAS. The changes of clinical indexes were observed in two groups, the serum leukocyte (WBC), alanine aminotransferase (ALT), direct bilirubin (DBil), albumin, prealbumin, transferrin, high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, renin (PRA), angiotensin-2 (ANG-2) and aldosterone (ALD) were compared on the fifirst day and the fourth day after surgery. Results The fifirst time to get out of bed, anal exhaust time, start eating time, infusion time, T tube clamping time and hospital stay were significantly shorter in the observation group than those in the control group (P<0.01). There were no signifificant differences in serum WBC, ALT, DBil, albumin, prealbumin, transferrin, hs-CRP, IL-6 and TNF-α levels in two groups on the fifirst day after surgery (P>0.05), the levels of WBC, ALT, DBil, hs-CRP, IL-6, TNF-α, PRA, ANG-2 and ALD in two groups on the fourth day after surgery were signifificantly lower than those on the fifirst day after surgery (P<0.01), and the levels of albumin, prealbumin and transferrin in two groups were also signifificantly higher than those on the fifirst day after surgery (P<0.01), while the corresponding indicators on the fourth day after surgery in the observation group were signifificantly lower or higher compared with the control group (P<0.01). Conclusion ERAS can promote the recovery of patients after laparoscopic common bile duct exploration T-tube choledochotomy, promote the recovery of liver function damage, and relieve the body' s inflflammation and stress. |
| Key words: Enhanced recovery after surgery laparoscopy common bile duct stones inflflammation stress response |
