【摘要】：目的:研究快速康復(fù)外科理念在結(jié)直腸癌圍手術(shù)期中的應(yīng)用效果,并探討其在地市級(jí)醫(yī)院結(jié)直腸癌手術(shù)中廣泛開(kāi)展的可行性。方法:根據(jù)入組條件收集2015年1月-2015年12月本院收治的62例行結(jié)直腸癌根治手術(shù)患者的臨床資料,根據(jù)圍手術(shù)期處置方式的不同分為快速康復(fù)組(n=30)和傳統(tǒng)處置組(n=32),對(duì)兩組患者的臨床資料進(jìn)行非隨機(jī)對(duì)照研究,比較兩組患者年齡、性別、腫瘤部位、合并的基礎(chǔ)疾病、腫瘤TNM分期、麻醉ASA評(píng)分、營(yíng)養(yǎng)評(píng)分、術(shù)中情況(術(shù)中出血、手術(shù)時(shí)間)、術(shù)后恢復(fù)情況(首次排氣和排便時(shí)間,疼痛NRS評(píng)分為0分所用時(shí)間)、術(shù)后并發(fā)癥發(fā)生率(吻合口瘺、肺部感染、心功能障礙、下肢深靜脈血栓、刀口感染、尿潴留、泌尿系統(tǒng)感染、術(shù)后腸梗阻、腹脹等)、住院時(shí)間、住院費(fèi)用、臨床常用檢驗(yàn)指標(biāo)(手術(shù)前后外周血白細(xì)胞計(jì)數(shù)、C-反應(yīng)蛋白、總蛋白、白蛋白),以及患者住院期間滿(mǎn)意度等指標(biāo)。結(jié)果:1.快速康復(fù)組與傳統(tǒng)處置組患者在年齡、性別、腫瘤部位、合并的基礎(chǔ)疾病、腫瘤TNM分期、麻醉ASA評(píng)分、營(yíng)養(yǎng)評(píng)分、術(shù)中出血量、手術(shù)時(shí)間方面無(wú)顯著差異性(P0.05),兩組患者具有可比性。2.快速康復(fù)組患者術(shù)后首次排氣時(shí)間為63.33±7.88min、首次排便時(shí)間為84.17±8.21min、疼痛NRS評(píng)分為0所用時(shí)間為3.82±0.66d、住院時(shí)間為11.63±2.16d,傳統(tǒng)處置組患者術(shù)后首次排氣時(shí)間為97.19±11.38min、首次排便時(shí)間為126.59±15.34min、疼痛NRS評(píng)分為0所用時(shí)間為5.36±1.02d、住院時(shí)間為16.03±1.18d,快速康復(fù)組患者術(shù)后首次排氣時(shí)間、首次排便時(shí)間、疼痛nrs評(píng)分為0所用時(shí)間及住院時(shí)間明顯短于傳統(tǒng)處置組,差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。兩組患者住院費(fèi)用分別為2.42±0.32萬(wàn)、3.19±0.22萬(wàn),快速康復(fù)組顯著低于傳統(tǒng)處置組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)�？焖倏祻�(fù)組患者術(shù)后并發(fā)癥發(fā)生率為13.3%(4/30)低于傳統(tǒng)處置組28.1%(9/32),但差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)�？焖倏祻�(fù)組術(shù)后第1天外周血白細(xì)胞計(jì)數(shù)為9.78±1.98×109/l、cpr為41.57±17.78mg/l,傳統(tǒng)處置組術(shù)后第1天外周血白細(xì)胞計(jì)數(shù)為12.79±1.98×109/l、cpr為97.22±29.79mg/l,與傳統(tǒng)處置組相比快速康復(fù)組患者術(shù)后白細(xì)胞計(jì)數(shù)、cpr水平更低,差異具有統(tǒng)計(jì)學(xué)意義(p0.05),快速康復(fù)組患者術(shù)后炎癥反應(yīng)更小�？焖倏祻�(fù)組術(shù)后第1天tp、alb分別為71.75±3.62g/l、38.99±2.49g/l,傳統(tǒng)處置組術(shù)后第1天tp、alb分別為69.66±3.41g/l、36.89±3.34g/l,快速康復(fù)組患者術(shù)中血清蛋白丟失量更少,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。3.快速康復(fù)組患者住院期間治療滿(mǎn)意率為93.3%(28/30),傳統(tǒng)處置組患者治療滿(mǎn)意率為71.8%(23/32),快速康復(fù)組患者對(duì)治療滿(mǎn)意度明顯高于傳統(tǒng)處置組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:1.快速康復(fù)外科理念應(yīng)用于結(jié)直腸癌圍手術(shù)期可顯著縮短患者術(shù)后胃腸道功能恢復(fù)時(shí)間,減輕術(shù)后疼痛,術(shù)后平均住院時(shí)間明顯縮短,醫(yī)療費(fèi)用有所減少,且不會(huì)增加術(shù)后吻合口瘺、刀口感染、術(shù)后腸梗阻等并發(fā)癥的發(fā)生率。2.快速康復(fù)外科理念在結(jié)直腸癌圍手術(shù)期中應(yīng)用可降低患者術(shù)后炎癥反應(yīng),手術(shù)過(guò)程中血清蛋白的丟失量更少,患者術(shù)后營(yíng)養(yǎng)狀態(tài)更好,患者滿(mǎn)意度較高。3.快速康復(fù)外科理念在結(jié)直腸癌圍手術(shù)期應(yīng)用是安全、有效的。4.快速康復(fù)外科理念在地市級(jí)醫(yī)院結(jié)直腸癌手術(shù)中安全可行,可以推廣應(yīng)用。
[Abstract]:Objective: To study the application of the concept of rapid rehabilitation surgery in the perioperative period of colorectal cancer and to explore its feasibility in the operation of colorectal cancer in the municipal hospitals. Methods: according to the conditions of the group, 62 patients with radical resection of colorectal cancer in December January 2015 -2015 were collected and the clinical data were collected and according to the perioperative operation. The different treatment methods were divided into the rapid rehabilitation group (n=30) and the traditional treatment group (n=32). The clinical data of the two groups were studied in a nonrandomized controlled study. The age, sex, site of the tumor, the underlying disease, the TNM staging of the tumor, the ASA score, the nutritional score, the intraoperative bleeding, the operation time and the postoperative recovery were compared. Conditions (first exhaust and defecation time, pain NRS score for 0 minutes), postoperative complications (anastomotic fistula, pulmonary infection, heart dysfunction, deep venous thrombosis of the lower extremities, knife mouth infection, urinary retention, urinary tract infection, postoperative intestinal obstruction, abdominal distention, etc.), hospitalization time, hospitalization expenses, and clinical test index (peripheral and before and after surgery) Blood leucocyte count, C- reactive protein, total protein, albumin, and patient satisfaction during hospitalization. Results there was no significant difference in age, sex, tumor site, combined basic disease, TNM staging, anesthesia ASA score, nutritional score, intraoperative bleeding, and operation time between the 1. rapid rehabilitation group and the traditional treatment group (P0. 05) the first exhaust time of the two groups was 63.33 + 7.88min, the first defecation time was 84.17 + 8.21min, the pain NRS score was 0, the time was 3.82 + 0.66d, the time of hospitalization was 11.63 + 2.16d, the first gas exhausting time of the traditional treatment group was 97.19 + 11.38min, and the first defecation time was 126.59 The pain NRS score was 0, the time was 5.36 + 1.02d and the hospitalization time was 16.03 + 1.18d. The first exhaust time of the patients in the rapid rehabilitation group, the first defecation time, the pain NRS score of 0 were significantly shorter than the traditional treatment group, and the difference was statistically significant (P0.05). The hospitalization expenses of the two groups were 2.42 + 0, respectively. .32 million, 3.19 + 2 thousand and 200, rapid rehabilitation group was significantly lower than the traditional treatment group, the difference was statistically significant (P0.05). The incidence of postoperative complications in the rapid rehabilitation group was 13.3% (4/30) lower than that of the traditional treatment group (9/32), but the difference was not statistically significant (P0.05). The white blood cell count in the fast recovery group was 9.78 + 1.98 * 109/l after first days after the operation. CPR was 41.57 + 17.78mg/l. The white blood cell count of the peripheral blood in the traditional treatment group was 12.79 + 1.98 x 109/l after first days, and CPR was 97.22 + 29.79mg/l. Compared with the traditional treatment group, the leukocyte count and the CPR level were lower in the rapid rehabilitation group. The difference was statistically significant (P0.05). The rapid rehabilitation group had less inflammatory response after operation. First days after the operation, TP, ALB was 71.75 + 3.62g/l, 38.99 + 2.49g/l respectively. The traditional treatment group was 69.66 + 3.41g/l, 36.89 + 3.34g/l after first days of operation, and the loss of serum protein was less in the rapid rehabilitation group (P0.05), the difference was statistically significant (P0.05) in the rapid rehabilitation group, the treatment satisfaction rate was 93.3% (28/30) and the traditional treatment was 93.3% (28/30). The satisfaction rate of the patients in the group was 71.8% (23/32). The satisfaction of the patients in the rapid rehabilitation group was significantly higher than that of the traditional treatment group. The difference was statistically significant (P0.05). Conclusion: the application of the concept of 1. rapid rehabilitation surgery to the perioperative period of colorectal cancer can significantly shorten the recovery time of the gastrointestinal function after operation, reduce postoperative pain, and live on average after operation. The hospital time is obviously shortened, the medical cost is reduced, and the postoperative complications such as anastomotic fistula, knife mouth infection, postoperative intestinal obstruction, and other complications,.2. rapid rehabilitation surgery concept can reduce the postoperative inflammatory reaction in the perioperative period of colorectal cancer, the loss of serum protein in the operation process is less, and the postoperative nutritional status of the patients. The concept of.3. rapid rehabilitation surgery is safe in the perioperative period of colorectal cancer. The effective.4. rapid rehabilitation surgery concept is safe and feasible in the operation of colorectal cancer in the city level hospital and can be popularized.
【學(xué)位授予單位】：濟(jì)寧醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R735.34

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