改良延续性护理对经腹腔镜远端胃切除术后胃癌患者手术应激及免疫功能的影响

  目的  分析基于加速康复外科理念的改良延续性护理对经腹腔镜远端胃切除术后的胃癌患者手术应激及免疫功能的影响。  方法  选择2018年6月—2020年6月新疆医科大学第一附属医院98例行经腹腔镜远端胃切除术的胃癌患者，并按随机数字表法分为观察组(49例)和对照组(49例)，对照组采用常规护理，观察组采用基于加速康复外科理念的改良延续性护理，比较术后不同阶段应激功能指标的变化；比较2组患者免疫功能指标的变化。  结果  2组患者术后第1、4、7天IL-6、IL-8、IL-10较术前均有所升高，且观察组术后第1、4、7天IL-6、IL-8水平明显低于对照组(均P＜0.05)；2组患者术后第1、4天CD4+、CD8+、CD4+/CD8+均有所下降，而术后第7天CD4+较术前升高，差异有统计学意义(均P＜0.05)，组间差异无统计学意义(P > 0.05)；2组患者术后第1、4天的IgA、IgG、IgM水平均相较于术前有所降低，组间差异有统计学意义(均P＜0.05)，第7天IgA、IgG、IgM基本回到术前水平，且观察组第1、4、7天IgA、IgG均高于对照组，组间差异有统计学意义(均P＜0.05)。  结论  基于加速康复外科理念的改良延续性护理可有效提高行经腹腔镜远端胃切除术的胃癌患者的临床效果，降低其应激炎性反应，并一定程度促进患者免疫功能的恢复与改善，进而促进术后胃癌患者的康复。 

Effect of improved continuous nursing on surgical stress and immune function in patients with gastric cancer after laparoscopic distal gastrectomy

  Objective  To analyze the impact of improved continuous nursing based on the concept of accelerated rehabilitation surgery on the surgical stress and immune function of gastric cancer patients after laparoscopic distal gastrectomy.  Methods  From June 2018 to June 2020, 98 patients with gastric cancer who underwent laparoscopic distal gastrectomy were selected from the First Affiliated Hospital of Xinjiang Medical University. They were divided into the observation group (49 cases) and control group (49 cases) according to the random number table method. The control group was given conventional nursing interventions, whereas the observation group was given improved continuous nursing based on the concept of accelerated rehabilitation surgery. Changes of stress function indexes at different stages and immune function indexes of both groups were compared after surgery.  Results  The levels of inflammatory mediators (IL-6, IL-8 and IL-10) of both groups on the 1st, 4th and 7th day after the operation increased compared with those before the operation, and the levels of IL-6 and IL-8 of the observation group were significantly lower than those of the control group (all P < 0.05). The two groups of patients had a decrease in CD4+, CD8+ and CD4+/CD8+ levels on the 1st and 4 th day after operation, while CD4+ increased on the 7th day after operation (all P < 0.05), and there was no significant difference between the two groups (P > 0.05). The levels of IgA, IgG and IgM on the 1st and 4th days decreased, and the difference between groups was statistically significant (all P < 0.05). On the 7th day, the levels of IgA, IgG and IgM basically returned to the preoperative level. The levels of IgA and IgG of the observation group on days 1, 4 and 7 were higher than those of the control group, and the difference between groups was statistically significant (all P < 0.05).  Conclusion  The improved continuous nursing based on the concept of accelerated rehabilitation surgery can effectively improve the clinical effect of gastric cancer patients undergoing laparoscopic distal gastrectomy, reduce their stress inflammatory response, promote the recovery and improvement of their immune function to a certain extent and promote their recovery after surgery.