【摘要】 目的探究与分析食管贲门癌手术联合糖皮质激素治疗对患者应激反应指标及炎症因子的影响。方法选取2014年7月至2016年6月收治的90例食管贲门癌患者,采取随机数字表法分为对照组与观察组,每组各45例。两组均给予传统开胸根治术治疗,观察组手术当日清晨给予10 mg/kg的甲泼尼松龙琥珀酸钠,两组术后均给予二代头孢抗感染。比较两组手术室后10 min(T0)、插管时(T1)、切皮时(T2)、手术开始后30 min(T3)、手术开始后1 h(T4)、拔管时(T5)围术期应激反应指标,术后1 d、3 d、5 d炎症因子水平,以及出院前切口甲类愈合率、抗生素使用天数,术后3月随访期间吻合口瘘率及吻合口狭窄率。结果对照组T1、T2、T3、T4、T5与T0相比心率(HR)、收缩压(SBP)及收缩压与心率的乘积(RPP)变化较为显著,差异具有统计学意义(P<0.05)。观察组T0、T1、T2、T3、T4、T5时刻下HR、SBP及RPP相比均无显著差异(P>0.05)。与对照组相比,观察组术后1 d、3 d、5 d的白细胞介素(IL)-6、IL-8、IL-10水平均较低,差异具有统计学意义(P<0.05)。与对照组相比,观察组切口甲类愈合率高、抗生素使用天数短、吻合口瘘率及吻合口狭窄率低,差异具有统计学意义(P<0.05)。结论食管贲门癌手术联合糖皮质激素治疗可减少患者的应激反应,降低炎症因子水平,随访期间不良事件发生率较低,安全性高。更多还原

【Abstract】 Objective To explore and analyze the influence of esophagus and cardia cancer surgery with glucocorticoid therapy on stress reaction index factors and inflammation. Methods From July 2014 to June 2016,90 cases of esophageal and cardia cancer patients by a random number table method were divided into control group and observation group,45 cases in each group. Patients in observation group were given 10 mg/kg of prednisone Long Hupo acid sodium in the early morning of surgery day,postoperative two group were given the second generation cephalosporins anti-infection. Perioperative stress response index,postoperative inflammatory factors level and discharge using the number of days before the class a healing rate of incision,antibiotics,postoperative anastomotic fistula rate during the follow-up period in March and the rate of anastomotic stenosis were compared. Results Compared with the control group,T1,T2,T3,T4,T5,and T0,HR,SBP and RPP changes were significant with statistical significant difference( P < 0. 05). T0 observe group,T1,T2,T3,T4,T5 moment of HR,SBP and RPP had no significant difference( P > 0. 05). Compared with control group,in observation group after 1 d,3 d,5 d after operation,postoperative IL-6,IL-8,IL-10 levels were lower with statistical significant difference( P < 0. 05). Compared with the control group,in observation group,rate of a healing of incision was higher,antibiotic using days was shorter,anastomotic fistula rate and anastomotic stenosis rate was lower with statistical significant difference( P < 0. 05). Conclusion Esophageal and cardia cancer surgery with glucocorticoid therapy can reduce the patient’s stress response,lower levels of inflammatory cytokines,lower incidence of adverse events during the follow-up period with high safety.更多还原