加速康复外科理念对宫颈癌根治术患者应激反应及T淋巴细胞水平的影响

目的探讨加速康复外科(ERAS)理念对宫颈癌根治术患者应激反应及T淋巴细胞水平的影响。方法选择2018年9月至2019年3月在该院接受治疗的46例宫颈癌根治术患者进行研究分析。按照随机数字表法将其分为对照组和研究组,每组23例。对照组患者给予传统围术期处理,研究组患者给予ERAS围术期处理。比较两组患者应激反应、T淋巴细胞水平及术后首次下床活动时间、首次排气时间、平均住院时间。结果对照组患者在拔管后10min(T2)和拔管后15min(T3)时刻的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)及Ramsay评分均明显高于研究组,差异均有统计学意义(P<0.05)。与拔管后5min(T1)时刻相比,研究组患者T2时刻的各指标差异无统计学意义(P>0.05),T3时刻的SBP、DBP、MAP、HR指标均明显升高,Ramsay评分明显降低,差异均有统计学意义(P<0.05)。对照组患者T2和T3时刻的SBP、DBP、MAP、HR指标均明显高于T1时刻,Ramsay评分明显低于T1时刻,差异均有统计学意义(P<0.05)。对照组患者在术后1d(T5)和术后2d(T6)时刻的CD3^+、CD4^+T淋巴细胞水平及CD4^+/CD8^+均明显低于研究组,差异均有统计学意义(P<0.05)。两组患者在T5和T6时刻的CD3^+、CD4^+、CD8^+T淋巴细胞水平及CD4^+/CD8^+明显低于T4时刻,差异均有统计学意义(P<0.05);两组患者术后首次下床活动时间、首次排气时间、平均住院时间比较差异均有统计学意义(P<0.05)。结论 ERAS应用于宫颈癌根治术患者可有效抑制患者的应激反应,使T淋巴细胞水平保持稳定,同时可促进患者胃肠功能恢复,缩短住院时间,加速患者术后康复,达到安全、经济、有效的护理,值得在临床上广泛使用。

Effects of ERAS on stress response and T lymphocyte levels in patients undergoing radical cervical cancer resection

Objective To investigate the effect of enhanced recovery after surgery(ERAS)on the stress response and T lymphocyte levels in the patients undergoing radical resection of cervical cancer.Methods Forty-six patients receiving radical cervical cancer resection in the hospital from September 2018 to March 2019 were selected for conducting the study and divided into the control group and study group according to the random number table method,23 cases in each group.The control group was given the conventional perioperative management,while the study group was given perioperative management of ERAS.The stress response,T lymphocyte levels,time to get out of bed after operation,first exhaust time,and average hospitalization time were compared between the two groups.Results The levels of SBP,DBP,MAP,HR and the Ramsay score at T2,and T3 in the control group were significantly higher than those in the study group(P<0.05).Compared with those at T1,there was no statistically significant difference in various indexes at the T2 in the study group(P>0.05).The levels of systolic pressure(SBP),diastolic pressure(DBP),mean arterial pressure(MAP)and heart rate(HR)indexes at T3 were significantly increased,the Ramsay score was significantly decreased,and the differences were statistically significant(P<0.05).In the control group,the levels of SBP,DBP,MAP and HR indexes at T2 and T3 were significantly higher than those at T1,and the Ramsay score was significantly lower than that at T1,and the differences were statistically significant(P<0.05).The CD3^+and CD4^+levels and CD4^+/CD8^+level at T5 and T6 in the control group were significantly lower than those in the study group,and the differences were statistically significant(P<0.05).The levels of CD3^+,CD4^+,CD8^+and CD4^+/CD8^+at T5 and T6 in the two groups were significantly lower than those at T4,and the differences were statistically significant(P<0.05).The time of getting out of bed,first exhaust time and average hospitalization time had statistically significant differences between the two groups(P<0.05).Conclusion ERAS can effectively inhibit the stress response of the patients with cervical cancer radical resection,stabilize the levels of T lymphocytes,meanwhile can promote the recovery of gastrointestinal function,shorten the length of hospital stay,accelerate postoperative rehabilitation,achieve the safe,economical and effective nursing care,and is worthy of widespread use in the clinic.