本文關(guān)鍵詞：快速康復外科對胃癌患者術(shù)后炎性反應及并發(fā)癥的影響　出處：《山西醫(yī)科大學》2016年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 快速康復外科 胃癌 炎癥反應 并發(fā)癥

【摘要】：目的:觀察采用快速康復外科治療(fast track surgery,FTS)對不同年齡段胃癌患者術(shù)后炎癥及并發(fā)癥的影響,探討其促進患者術(shù)后快速康復的機制及臨床價值。方法:選擇經(jīng)纖維胃鏡及腹部CT檢查結(jié)果確診的胃癌患者126例作為病例組,制定納入標準和排除標準,根據(jù)年齡段分為小于等于64歲患者(63例)和大于等于65歲患者(63例)兩大組,再對每一大組根據(jù)治療方法不同分為快速康復治療組(FTS,實驗組)和傳統(tǒng)治療組(CC,對照組),即小于等于64歲患者組為快速康復治療組(FTS-1,32例)和傳統(tǒng)治療組(CC-1,31例),大于等于65歲患者組為快速康復治療組(FTS-2,31例)和傳統(tǒng)治療組(CC-2,32例)。對所有入組患者分別在手術(shù)前1天、術(shù)后1天及術(shù)后3天進行抽取靜脈血,通過雙抗體夾心ELISA法檢測血清中IL-6、IL-10及TNF-α濃度,采用上轉(zhuǎn)發(fā)光免疫層析定量檢測PCT血清濃度。利用SPSS19.0數(shù)據(jù)統(tǒng)計學軟件處理分析,檢驗水準以a=0.05為標準。結(jié)果:不同年齡段患者的一般資料特征比較,包括年齡,性別,手術(shù)時間,ASA評分,手術(shù)類型,重建類型,腫瘤TNM分期階段、合并癥(高血壓病、心血管疾病、肺部疾病、糖尿病、腎臟疾病)(這些指標P0.05),然而,除不同年齡段患者的年齡之間有差異(P0.05,),四組患者其他任何特征均無差異。不同年齡段在快速康復外科組術(shù)后1天、3天的血清PCT與促炎癥因子IL-6和TNF-α水平升高幅度低于同期傳統(tǒng)治療組,而血清抗炎癥因子IL-10水平升高幅度高于同期傳統(tǒng)治療組(P0.05)。術(shù)后臨床觀察恢復情況為:1)在快速康復外科組術(shù)后首次排氣時間和術(shù)后住院時間明顯縮短分別為[(3.2±0.6和3.5±0.5,P=0.021)和(6.2±1.4和10.0±2.2,p=0.000)],然而,研究表明fts-2和cc-2組之間無顯著性差異,其分別為[(3.4±0.3和3.6±0.3,p=0.053)和(10.1±1.5和10.8±1.2,p=0.056)]。2)與傳統(tǒng)治療組比較,使用快速康復外科組住院總費用明顯降低,該組為(36.3±2.8和38.0±3.1千元,p=0.025),但在fts-2和cc-2組之間無顯著性差異,該組為(40.9±1.5和41.7±1.8千元,p=0.061)。3)30天內(nèi)術(shù)后再住院率在fts和cc組之間沒有差異(p0.05)。術(shù)后并發(fā)癥比較:1)在fts-2組術(shù)后肺部感染及泌尿道感染發(fā)生率比傳統(tǒng)治療組明顯降低[(3/31和10/32,p=0.034),和(2/31和9/32,p=0.023)],但fts-1和cc-1組之間沒有顯著差異(分別為p=0.670,p=0.368和p=0.638);2)fts-1和cc-1組之間的術(shù)后惡心嘔吐發(fā)生率沒有差異(5/32和3/31,p=0.741),然而,在fts-2組明顯增加(9/31和3/32,p=0.047);3)在快速康復外科組術(shù)后腸梗阻發(fā)生率顯著降低(3/32和9/31,p=0.047),但fts-2和cc-2組之間沒有顯著差異(3/31和5/32,p=0.,741);4)在同一年齡段范圍內(nèi),不同治療組之間的術(shù)后并發(fā)癥發(fā)生率沒有顯著差異(如咽喉炎、胃潴留、尿潴留、吻合口瘺、切口感染、下肢深靜脈血栓形成)(全部p0.05)。結(jié)論:1.快速康復外科治療對胃癌手術(shù)患者創(chuàng)傷較小,能夠明顯降低患者術(shù)后炎癥反應。2.對于年輕胃癌手術(shù)患者("f64歲),快速康復外科治療能夠降低其術(shù)后腸梗阻發(fā)生率,縮短術(shù)后肛門排氣時間及術(shù)后住院時間,減少總住院費用。3.對于老年胃癌手術(shù)患者("g65歲),快速康復外科治療能夠降低其術(shù)后惡心嘔吐、肺部感染及尿道感染發(fā)生率,而對術(shù)后肛門排氣時間、術(shù)后住院時間及總住院費用沒有影響。4.快速康復外科治療對胃癌患者術(shù)后的咽喉炎、胃潴留、吻合口漏、尿潴留、切口感染及下肢靜脈血栓形成及再次住院人數(shù)并沒有影響。
[Abstract]:Objective: To observe the use of rapid rehabilitation surgical treatment (fast track surgery, FTS) of different ages of patients with gastric cancer and inflammatory complications, explore the clinical value and its mechanism for patients with rapid rehabilitation. Methods: by endoscopy and abdominal CT examination results of 126 gastric cancer patients diagnosed as cases formulation, inclusion criteria and exclusion criteria, according to the age is less than or equal to 64 year old patients (63 cases) and greater than or equal to 65 year old patients (63 cases) two groups, then each group according to the different treatment methods for the rapid rehabilitation treatment group (FTS, experimental group and conventional treatment group (CC) that is less than or equal to the control group), 64 year old patient group for the rapid rehabilitation treatment group (FTS-1,32 cases) and conventional treatment group (CC-1,31 cases), greater than or equal to 65 patients for the rapid rehabilitation treatment group (FTS-2,31 cases) and conventional treatment group (CC-2,32 cases). All patients were divided into the group of Don't 1 days before surgery, after 1 days and 3 days after operation for venous blood serum was detected by IL-6 double antibody sandwich ELISA method, IL-10 and TNF- concentrations, turn light PCT serum concentrations measured by quantitative immunochromatography. Using statistical analysis software SPSS19.0 data processing, inspection level a=0.05 standard. Results: compared with general information, characteristics of patients with different ages including age, gender, operation time, ASA score, type of surgery, reconstruction type, TNM stage of the tumor stage, comorbidities (hypertension, cardiovascular disease, lung disease, diabetes, kidney disease (P0.05) of these indicators, however, except between patients) different age age difference (P0.05), there was no difference between the four groups in any other characteristics. Different ages in fast track surgery group after 1 days, 3 days of serum PCT and pro inflammatory factors IL-6 and TNF- levels significantly lower than the same period 浼犵粺娌葷枟緇，

本文編號：1434462