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目的评价在非微创手术条件下快速流程(fast-track,FT)围手术期临床管理对结直肠癌围手术期炎性反应的影响。方法将55例择期结直肠癌手术患者随机分为2组,分别接受FT围手术期管理(FT组,n=29)和传统围手术期管理(传统组,n=26),均接受常规非微创开腹手术,检测2组患者术前24h及术后24h、72h和7d共4个截点的血浆C反应蛋白(CRP)和血浆淀粉样蛋白(SAA)浓度并作统计学分析。结果 2组患者均无影响实验结果的并发症发生,均无手术死亡。2组内患者的CRP和SAA浓度变化趋势一致。FT组患者CRP和SAA浓度在术后24h即达到峰值〔CRP:(72.36±60.94)mg/L;SAA:(328.97±267.20)mg/L〕,传统组峰值推后,出现于术后72h〔CRP:(112.71±63.92)mg/L;SAA:(524.18±331.03)mg/L〕;术后72h时FT组CRP和SAA浓度已经开始下降〔CRP:(57.21±30.42)mg/L;SAA:(237.43±215.66)mg/L〕;FT组CRP及SAA峰值均明显低于传统组(P<0.001);术后72h时FT组CRP和SAA浓度明显低于传统组(P<0.001)。术后7d,2组患者CRP和SAA浓度进一步下降,组间比较差异无统计学意义(P>0.05);且均低于各组内术后24h及72h时的CRP和SAA值(P<0.001),但均高于各组内术前24h的CRP和SAA值(P<0.001)。结论在非微创手术条件下,快速流程围手术期临床管理可显著减轻结直肠癌手术的炎性反应,科学的临床管理也是促进患者快速康复的重要手段。
Objective To evaluate the effect of perioperative clinical management of fast-track (FT) perioperative inflammatory response in colorectal cancer under non-minimally invasive surgery. Methods Fifty-five patients undergoing elective colorectal cancer surgery were randomly divided into two groups. The patients underwent FT perioperative management (FT group, n = 29) and conventional perioperative management (n = 26) The patients underwent minimally invasive laparotomy. The plasma C-reactive protein (CRP) and plasma amyloid protein (SAA) concentrations were measured at 24 h, 24 h, 72 h, and 7 d after operation in both groups and analyzed statistically. Results The two groups of patients did not affect the outcome of the experimental complications, no surgical death. The trend of CRP and SAA concentration in patients in two groups were the same. The CRP and SAA concentrations in FT group reached the peak at 24 hours after operation (CRP: (72.36 ± 60.94) mg / L and SAA: (328.97 ± 267.20) mg / L, CRP: (112.71 ± 63.92) mg / L; SAA: (524.18 ± 331.03) mg / L〕; The CRP and SAA concentrations in FT group started to decline at 72h after operation [CRP: (57.21 ± 30.42) mg / (237.43 ± 215.66) mg / L]. The peak levels of CRP and SAA in FT group were significantly lower than those in the conventional group (P <0.001). The levels of CRP and SAA in FT group were significantly lower than those in the conventional group at 72 hours after operation (P <0.001). After 7 days, CRP and SAA concentrations in both groups were further decreased, with no significant difference between the two groups (P> 0.05), and were lower than those of CRP and SAA at 24h and 72h ), But higher than the CRP and SAA values (P <0.001) 24h before surgery in each group. Conclusion In non-minimally invasive surgery, rapid management of perioperative clinical management can significantly reduce the inflammatory response to colorectal cancer surgery. Scientific clinical management is also an important means to promote rapid recovery of patients.