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

汤婷; 张强; 王翔; 何丽芸; 张文斌

doi:10.16766/j.cnki.issn.1674-4152.002478

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

doi: 10.16766/j.cnki.issn.1674-4152.002478

汤婷¹,
张强¹,
王翔¹,
何丽芸¹,
张文斌^2, ,

1.
新疆医科大学第一附属医院中心手术室，新疆乌鲁木齐 830054
2.
新疆医科大学第一附属医院胃肠(肿瘤)外科，新疆乌鲁木齐 830054

基金项目:

国家卫生计生委医药卫生科技发展研究中心科研项目 W2017ZWS05

详细信息

通讯作者:
张文斌, E-mail：zwb3216@sina.com

中图分类号: R473.6 R735.2
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出版历程
- 收稿日期: 2021-04-18
- 网络出版日期: 2022-09-05

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

1.
Central Operating Room, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China

摘要

摘要: 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。
- 加速康复外科理念 /
- 改良延续性护理 /
- 经腹腔镜远端胃切除 /
- 应激功能 /
- 免疫功能
Abstract: 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.
- Accelerated rehabilitation surgery concept /
- Improved continuous nursing /
- Laparoscopic distal gastrectomy /
- Stress function /
- Immune function

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表 1 2组胃癌患者临床指标对比

Table 1. Comparison of clinical indicators between two groups of gastric cancer patients

组别	例数	首次排便时间 (x±s, h)	首次排气时间 (x±s, h)	并发症 [例(%)]
观察组	49	22.74±2.34	29.64±2.47	5(10.20)
对照组	49	31.68±2.78	35.73±2.79	14(28.57)
统计量		17.222^a	11.440^a	5.288^b
P值		< 0.001	< 0.001	0.021
注：^a为t值，^b为χ²值。

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表 2 2组胃癌患者应激指标炎性介质比较(x±s)

Table 2. Comparison of inflammatory mediators of stress index between two groups of gastric cancer patients (x±s)

组别	例数	IL-6(ng/L)
组别	例数	术前	术后第1天	术后第4天	术后第7天
观察组	49	2.43±0.35	35.26±3.24^a	23.57±2.46^ab	11.28±1.23^abc
对照组	49	2.39±0.34	49.52±4.76^a	37.64±3.59^ab	15.86±1.63^abc
t值		0.574	17.336	22.631	15.700
P值		0.567	< 0.001	< 0.001	< 0.001

组别	例数	IL-8(ng/L)
组别	例数	术前	术后第1天	术后第4天	术后第7天
观察组	49	1.82±0.25	27.45±3.54^a	11.58±1.32^ab	2.86±0.63^abc
对照组	49	1.79±0.24	34.42±4.06^a	23.17±2.21^ab	9.56±1.05^abc
t值		0.606	9.058	31.517	38.301
P值		0.546	< 0.001	< 0.001	< 0.001

组别	例数	IL-10(ng/L)
组别	例数	术前	术后第1天	术后第4天	术后第7天
观察组	49	125.62±5.89	207.43±9.78^a	175.45±8.45^ab	167.47±7.35^abc
对照组	49	123.86±5.67	199.56±9.12^a	145.42±6.40^ab	141.32±6.53^abc
t值		1.507	4.120	19.831	18.618
P值		0.135	< 0.001	< 0.001	< 0.001
注: 与同组术前比较，^aP < 0.05;与同组手术后第1天比较，^bP < 0.05;与同组术后第4天比较，^cP < 0.05。

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表 3 2组胃癌患者细胞免疫指标比较(x±s)

Table 3. Comparison of cellular immune indexes between two groups of gastric cancer patients (x±s)

组别	例数	CD4⁺(%)
组别	例数	术前	术后第1天	术后第4天	术后第7天
观察组	49	31.57±1.54	29.25±1.21^a	31.29±1.56^b	36.28±1.83^abc
对照组	49	31.38±1.49	27.54±1.22^a	30.64±3.59^b	35.96±1.81^abc
t值		0.621	47.705	1.162	0.870
P值		0.536	< 0.001	0.248	0.386

组别	例数	CD8⁺(%)
组别	例数	术前	术后第1天	术后第4天	术后第7天
观察组	49	24.12±2.23	21.02±2.04^a	22.59±2.12^b	23.86±2.15^bc
对照组	49	23.89±2.21	20.82±2.06^a	21.67±2.11^b	22.98±2.14^bc
t值		0.513	0.483	2.153	2.031
P值		0.609	0.630	0.034	0.045

组别	例数	CD4⁺/CD8⁺
组别	例数	术前	术后第1天	术后第4天	术后第7天
观察组	49	1.32±0.19	1.29±0.18	1.15±0.15	1.42±0.22
对照组	49	1.29±0.17	1.27±0.16	1.16±0.14	1.43±0.23
t值		0.824	0.581	0.341	0.220
P值		0.412	0.562	0.734	0.826
注: 与同组术前比较，^aP < 0.05;与同组手术后第1天比较，^bP < 0.05;与同组术后第4天比较，^cP < 0.05。

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表 4 2组胃癌患者体液免疫指标比较(x±s, g/L)

Table 4. Comparison of humoral immune indexes between two groups of gastric cancer patients (x±s, g/L)

组别	例数	IgA
组别	例数	术前	术后第1天	术后第4天	术后第7天
观察组	49	2.17±0.14	1.85±0.11^a	2.16±0.15^b	2.23±0.17^bc
对照组	49	2.18±0.15	1.54±0.09^a	1.64±0.14^b	2.06±0.16^bc
t值		0.341	15.268	17.740	5.097
P值		0.734	< 0.001	< 0.001	< 0.001

组别	例数	IgG
组别	例数	术前	术后第1天	术后第4天	术后第7天
观察组	49	12.11±1.23	10.82±1.04^a	10.27±1.32^b	12.36±1.25
对照组	49	11.89±1.21	10.02±1.06^a	9.26±1.17^b	11.78±1.18
t值		0.893	3.771	4.008	2.362
P值		0.374	< 0.001	< 0.001	0.020

组别	例数	IgM
组别	例数	术前	术后第1天	术后第4天	术后第7天
观察组	49	1.62±0.13	0.91±0.08^a	1.51±0.11^b	1.61±0.12^bc
对照组	49	1.59±0.12	0.90±0.08^a	1.47±0.12^b	1.60±0.12^bc
t值		1.187	0.619	1.720	0.412
P值		0.238	0.538	0.089	0.681
注: 与同组术前比较，^aP < 0.05;与同组手术后第1天比较，^bP < 0.05;与同组术后第4天比较，^cP < 0.05。

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