發(fā)布時(shí)間：2018-05-21 11:23

  本文選題：快速康復(fù) + 腹腔鏡　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景胃癌作為我國(guó)死亡率第三位的惡性腫瘤,一直是我國(guó)衛(wèi)生、經(jīng)濟(jì)的一大負(fù)擔(dān)。每年胃癌新發(fā)病例40余萬,因胃癌死亡病例30余萬[1],約占全國(guó)人群總癌死亡的15%和總死亡的3%[2]。當(dāng)今我國(guó)已成為老齡化國(guó)家,老年人所占比例逐年上升,各種伴隨的疾病及其負(fù)擔(dān)也會(huì)接踵而至。老年患者的一般身體情況、生理狀態(tài)及免疫功能相較于年輕人有所差異[3]�？焖倏祻�(fù)外科(fast-track surgery FTS)最先由丹麥醫(yī)師提出,逐漸在國(guó)內(nèi)外開展臨床試驗(yàn)及研究,通過優(yōu)化圍手術(shù)期干預(yù)措施,減少對(duì)患者內(nèi)環(huán)境的騷擾,加速術(shù)后恢復(fù),是近年來研究的熱點(diǎn)。腹腔鏡技術(shù)自上世紀(jì)90年代應(yīng)用于胃腸外科后,經(jīng)過發(fā)展和完善,腹腔鏡胃癌根治術(shù)已應(yīng)用于胃癌患者,取得了不錯(cuò)的療效。鑒于老年胃癌患者的差異性,快速康復(fù)外科理念不能照搬以往的經(jīng)驗(yàn),本文將以此展開研究和論述。目的將快速康復(fù)理念應(yīng)用于行腹腔鏡胃癌根治術(shù)的老年患者,探討其術(shù)后近期療效及對(duì)炎癥反應(yīng)的影響。方法自2014年10月至2016年10月,于鄭州大學(xué)人民醫(yī)院胃腸外科行腹腔鏡胃癌根治術(shù)的老年患者92例,其中納入快速康復(fù)路徑患者46人(觀察組),納入常規(guī)治療46例(對(duì)照組),回顧性分析其病例資料和生化檢查結(jié)果,比較兩組C反應(yīng)蛋白(C reactive protein,CRP)、降鈣素原(procalcitonin,PCT)、術(shù)后首次肛門排氣時(shí)間、平均住院日等資料。運(yùn)用SPSS 24.0進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果兩組患者CRP及PCT均較術(shù)前有所增高,對(duì)照組增高更明顯(P0.05)。術(shù)后第1、4、7天觀察組CRP為:17.19±11.14(mg/L)、13.81±4.17(mg/L)、6.98±1.98(mg/L),對(duì)照組CRP:24.91±17.88(mg/L)、19.91±7.79(mg/L)、8.70±1.84(mg/L)。術(shù)后第1、4、7天觀察組PCT:1.59±1.29ng/mL、1.41±1.16ng/mL、0.59±0.40ng/mL,對(duì)照組PCT:2.30±1.20ng/mL、1.87±1.24ng/mL、0.71±0.42ng/mL。術(shù)后觀察組首次通氣時(shí)間50.38±10.83h,對(duì)照組為69.86±14.72h;平均住院時(shí)間觀察組9.10±2.53d,對(duì)照組11.05±2.94d,觀察組相較對(duì)照組,首次通氣時(shí)間、平均住院日更短,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組共有5例出現(xiàn)術(shù)后并發(fā)癥,發(fā)生率10.87%。對(duì)照組共有7例出現(xiàn)并發(fā)癥,發(fā)生率15.22%。兩組患者并發(fā)癥發(fā)生率,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論對(duì)于行腹腔鏡胃癌根治術(shù)的老年患者,圍術(shù)期在快速康復(fù)理念指導(dǎo)下進(jìn)行術(shù)后康復(fù),可取得滿意的臨床效果。
[Abstract]:Background as the third leading malignant tumor in China, gastric cancer has been a great burden of health and economy in China. There are more than 400,000 new cases of gastric cancer every year, and more than 300,000 deaths due to gastric cancer, accounting for 15% of total cancer deaths and 3% of total deaths in China. Nowadays, China has become an aging country, the proportion of the elderly is increasing year by year, and various accompanying diseases and their burdens will follow. The general physical condition, physiological state and immune function of the elderly patients are different from those of the young people [3]. Fast-track surgery FTS was first put forward by Danish doctors. It is a hot topic in recent years to develop clinical trials and research at home and abroad. By optimizing perioperative intervention measures, reducing disturbance to patients' internal environment and accelerating postoperative recovery are the hot topics in recent years. Since its application in gastrointestinal surgery in 1990s, laparoscopic radical gastrectomy has been applied to patients with gastric cancer. In view of the difference of the elderly patients with gastric cancer, the concept of rapid rehabilitation surgery can not be copied from the previous experience. Objective to apply the idea of rapid rehabilitation to the elderly patients undergoing laparoscopic radical gastrectomy, and to explore the short-term effect of laparoscopic radical gastrectomy and its influence on inflammatory reaction. Methods from October 2014 to October 2016, 92 elderly patients underwent laparoscopic radical gastrectomy in the people's Hospital of Zhengzhou University. Among them, 46 patients were included in the rapid rehabilitation path (observation group) and 46 patients were included in routine therapy (control group). The case data and biochemical examination results were analyzed retrospectively. The data of C-reactive protein (CRP), procalcitonin (PCT), the first anal exhaust time after operation and the average hospitalization time were compared between the two groups. SPSS 24.0 was used for statistical analysis. Results the CRP and PCT in both groups were higher than those before operation, and the increase in control group was more obvious than that in the control group (P 0.05). The CRP of the observation group was 13.81 鹵4.17 mg / L on the 1st day after operation, and that of the control group was 19.91 鹵7.79 mg / L and 8.70 鹵1.84 mg / L respectively, and that of the control group was 6.98 鹵1.98 mg / L and 19.91 鹵7.79 mg / L respectively. The PCT:1.59 鹵1.29ng / mLL of the observation group was 1.41 鹵1.16ng / mL 0.59 鹵0.40ng / mL on the 7th day after operation, and that of the control group was PCT:2.30 鹵1.20ng / mL0.87 鹵1.24ng / mL 0.71 鹵0.42ng / mL. The first ventilation time was 50.38 鹵10.83 hours in the observation group and 69.86 鹵14.72 hours in the control group, and the average hospitalization time was 9.10 鹵2.53 days in the observation group and 11.05 鹵2.94 days in the control group. In the observation group, there were 5 cases of postoperative complications (10.87%). There were 7 cases of complications in the control group, the incidence was 15.22%. There was no significant difference in the incidence of complications between the two groups (P 0.05). Conclusion for the elderly patients undergoing laparoscopic radical gastrectomy, the postoperative rehabilitation under the guidance of the idea of rapid rehabilitation in perioperative period can obtain satisfactory clinical results.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王寶華;王寧;馮雅靖;殷鵬;李鎰沖;劉世煒;周脈耕;;1990年與2013年中國(guó)人群胃癌疾病負(fù)擔(dān)分析[J];中華流行病學(xué)雜志;2016年06期

2 裴泓波;蒲宏全;代敏;白亞娜;昌盛;王正芳;程寧;李海燕;李娟生;胡曉斌;任曉衛(wèi);;金昌隊(duì)列人群胃癌疾病負(fù)擔(dān)研究[J];中華流行病學(xué)雜志;2016年03期

3 李國(guó)新;;中國(guó)腹腔鏡胃癌外科臨床研究現(xiàn)狀[J];中華消化外科雜志;2016年01期

4 何洪生;曾文龍;朱柏?zé)?杜永御;賴楊城;;胃癌根治術(shù)患者術(shù)后早期腸內(nèi)營(yíng)養(yǎng)治療的效果研究[J];中外醫(yī)學(xué)研究;2015年36期

5 徐佳昕;蔡明琰;周平紅;李歡;黃晨;;內(nèi)鏡下切除與傳統(tǒng)外科手術(shù)治療早期胃癌的療效對(duì)比[J];中華胃腸外科雜志;2015年11期

6 Marília Cravo;Catarina Fidalgo;Rita Garrido;Tania Rodrigues;Gon?alo Luz;Carolina Palmela;Marta Santos;Fábio Lopes;Rui Maio;;Towards curative therapy in gastric cancer:Faraway, so close![J];World Journal of Gastroenterology;2015年41期

7 徐惠綿;苗智峰;;2014版《胃癌臨床實(shí)踐指南》解讀[J];中華醫(yī)學(xué)信息導(dǎo)報(bào);2015年02期

8 孟成;于洋;王智浩;李宇;曹守根;韓洪鼎;周巖冰;;加速康復(fù)外科在胃癌根治術(shù)中臨床價(jià)值的前瞻性研究[J];中華消化外科雜志;2015年01期

9 張煥長(zhǎng);肖煥擎;張峰;;胃癌根治術(shù)快速康復(fù)外科隨機(jī)對(duì)照試驗(yàn)的Meta分析[J];消化腫瘤雜志(電子版);2014年03期

10 薛秋楓;;快速康復(fù)外科在進(jìn)展期胃癌病人圍術(shù)期中的應(yīng)用[J];護(hù)理研究;2014年18期

，

本文編號(hào)：1918997