【摘要】 目的:观察加速康复外科(FTS)对胃癌病人手术后近期临床结局的影响。方法:将106例胃癌病人随机分为对照组(n=53,采用常规围手术期处理方案)和FTS组(n=53,采用加速康复围手术期处理方案)。动态监测比较两组病人术前和术后第1、3、7天血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和C-反应蛋白(CRP)水平。同时记录空腹血糖(FBG)、空腹胰岛素定量(FINS)。根据稳态模式评估法(HOMA)计算胰岛素抵抗指数(HOMA-IR),并比较两组病人术后发热时间、肛门排气时间、住院天数、住院费用和并发症的发生等情况。结果:FTS组病人术后第1和第3天IL-6、TNF-α和lnHOMA-IR明显低于对照组;术后第1、3和第7天,CRP明显低于对照组(P<0.05);FTS组病人术后发热时间、肛门排气时间、住院天数和住院费用明显少于对照组(P<0.05),而术后并发症的发生并未增加(P>0.05)。结论:FTS措施能降低胃癌病人手术后的胰岛素抵抗,减轻应激反应,加速病人的康复。更多还原

【Abstract】 Objective: To investigate the influence of fast tract surgery on recent clinical outcomes in gastric cancer patients.Methods: 106 patients with gastric cancer receving radical operation were randomly divided into two groups: fast track group and control group.Serum levels of TNF-α,IL-6,CRP and fasting blood glucose(FBG)and fasting insulin(FINS) in 106 patients were assayed preoperatively and on 1st,3rd,7th day postoperatively,and insulin resistance index(HOMA-IR)was calculated using Homeostasis Model Assessment(HOMA)to evaluate insulin sensitivity.The postoperative hospital stay,duration of fever,medical cost,postoperative time of flatus and postoperative complications were recorded respectively.Results: On the postoperative 1st and 3rd day,serum levels of TNF-α,IL-6 and lnHOMA-IR in patients in fast track group were significantly lower than those in patients in control group(all P<0.05).On the postoperative 1st,3rd and 7th day,serum levels of CRP in patients in fast track group were significantly lower than those in patients in control group(all P<0.05).The postoperative duration of fever,postoperative time of flatus and postoperative hospital stay and treatment expense in patients in fast track group were also significantly lower than those in control group(all P<0.05).Patients in fast track group had no more complications than those in non-fast track group(P>0.05).Conclusion: Fast tract surgery can reduce the incidence and the degree of insulin resistance and lessen stress reaction in gastric cancer patients during perioperative period.更多还原