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目的探讨快速康复外科(fast track surgery,FTS)应用于结直肠癌根治术的术中最佳管理方法。方法选择我院2008年10月至2010年5月行结直肠癌根治手术患者182例,随机分为试验组(n=94)与对照组(n=88)。试验组采用针对FTS各种术中的措施包括良好宣教、术中硬膜外麻醉及应用硬膜外镇痛泵、适当控制补液量及采取保温措施、不常规应用各种引流管等的术中管理,对照组则为传统管理方法。进行两组术前即刻心率、血压、术前后血浆皮质醇值变化及术后寒战、恶心呕吐、疼痛、咽喉炎发生率的比较。结果两组间的麻醉前即刻心率(x-±s,min)、收缩压(x-±s,mm Hg):试验组分别为(72.33±10.21)、(117.57±8.85),对照组分别为(93.48±4.11)、(138.94±8.56)。相比较P<0.01,具有显著性差异。两组血浆皮质醇值(ng/ml)于术前24h、术后24h测量:试验组为(111.98±9.53)、(184.54±12.38),对照组为(113.92±8.42)、(293.86±6.96)。术前24h值两组无较大差异(P>0.05),术后24h值间差异具有显著性(P<0.01)。术后寒战、恶心呕吐、疼痛、咽喉炎发生例数:试验组分别为5、0、2、0,对照组分别为40、18、49、7,两组间差异具有显著性(P<0.01)。结论实施FTS的管理方法,使结直肠癌根治手术患者更为舒适地度过了手术期,减少了应激反应及并发症,利于患者术后康复。
Objective To explore the best intraoperative operative management method of fast track surgery (FTS) applied in radical resection of colorectal cancer. Methods A total of 182 patients undergoing radical surgery for colorectal cancer from October 2008 to May 2010 in our hospital were randomly divided into experimental group (n = 94) and control group (n = 88). The experimental group used a variety of surgical procedures for FTS, including good mission, intraoperative epidural anesthesia and the application of epidural analgesia pump, appropriate control of fluid volume and take insulation measures, not routine use of various drainage tubes and other surgery Management, control group is the traditional management methods. Preoperative heart rate, blood pressure, preoperative and postoperative plasma cortisol values and postoperative chills, nausea, vomiting, pain, sore throat were compared. Results The heart rate (x- ± s, min) and systolic pressure (x- ± s, mm Hg) immediately before anesthesia in the two groups were (72.33 ± 10.21) and (117.57 ± 8.85), respectively (93.48 ± 4.11), (138.94 ± 8.56). Compared with P <0.01, there is a significant difference. The levels of plasma cortisol (ng / ml) in the two groups were measured at 24h before surgery and 24 hours after surgery. The levels of plasma cortisol in the two groups were (111.98 ± 9.53) and (184.54 ± 12.38) and 113.92 ± 8.42 and (293.86 ± 6.96) . There was no significant difference between the two groups before operation (P> 0.05) and 24h after operation (P <0.01). Postoperative chills, nausea and vomiting, pain, sore throat cases: the test group were 5,0,2,0, respectively, the control group were 40,18,49,7, the difference between the two groups was significant (P <0.01 ). Conclusion The implementation of FTS management method, so that patients with radical resection of colorectal surgery more comfortable through the operation, reducing the stress response and complications, which will help patients recover.