加速康复外科对腹腔镜胃癌根治术患者预后、负面情绪及心理应激的影响
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摘要
目的探讨加速康复外科(enhanced recovery after surgery,ERAS)对腹腔镜胃癌根治术患者预后、负面情绪及心理应激的影响。方法选取2016年1月至2018年5月于铜陵市人民医院拟择期行腹腔镜胃癌根治术的130例患者为研究对象,采用随机数表法将入选患者分为观察组和对照组,每组各65例。对照组患者采用传统围术期干预,观察组患者在围术期给予ERAS综合干预。比较两组患者预后指标及手术前后不同时间点汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、应激反应问卷(stress response questionnaire,SRQ)各维度评分。结果全部患者均顺利完成腹腔镜胃癌根治术,观察组患者首次排气时间、首次进食时间、下床活动时间、胃管拔除时间、术后住院天数均显著短于对照组(P_均<0.05)。观察组患者术前1 h、术后48 h HAMA、HAMD及SRQ各维度评分均显著低于本组入院即刻(P_均<0.05),对照组患者术前1 h SRQ躯体反应评分及术后48 h HAMA、HAMD、SRQ各维度评分均显著低于本组入院即刻(P_均<0.05)。观察组患者术前1 h、术后48 h HAMA、HAMD及SRQ各维度评分均显著低于同期对照组(P_均<0.05)。结论 ERAS能显著促进腹腔镜胃癌根治术患者的胃肠道功能恢复,改善预后,明显缓解患者围术期的焦虑和抑郁情绪,减轻心理应激反应,值得临床推广应用。
Objective To investigate the effect of enhanced recovery after surgery(ERAS) on prognosis, negative emotion and psychological stress in patients with undergoing laparoscopic radical resection of gastric carcinoma. Method 130 patients underwent laparoscopic radical resection of gastric carcinoma in Tongling People's Hospital from January 2015 to December 2017 were enrolled for the study and divided into observation group and control group according to random number table method, 65 cases in each group. Patients in control group were given traditional perioperative intervention, patients in observation group were given ERAS comprehensive intervention. The postoperative recovery indexes, scores of Hamilton depression scale(HAMD), Hamilton anxiety scale(HAMA) and stress response questionnaire(SRQ) were compared between two groups at different time points. Result All patients successfully completed laparoscopic radical resection of gastric carcinoma. The first exhaust time, first eating time, time of beginning get out of bed, stomach tube extubation time, postoperative hospitalization days in observation group were significantly shorter than those in control group(P_(all)< 0.05). The scores of HAMA, HAMD and all dimensions of SRQ at 1 hour before operation and 48 hours after operation in observation group were significantly lower than those at hospitalization(P_(all)< 0.05), while somatic reaction score of SRQ at 1 hour before operation, scores of HAMA, HAMD and all dimensions of SRQ at 48 hours after operation in control group were significantly lower than those at hospitalization(P_(all)< 0.05). The scores of HAMA, HAMD and all dimensions of SRQ at 1 hour before operation and 48 hours after operation in observation group were significantly lower than those in control group at the same time(P_(all)< 0.05). Conclusion ERAS can significantly promote the recovery of gastrointestinal function and improve prognosis in patients with gastric cancer undergoing laparoscopic radical resection of gastric carcinoma, and it also can significantly alleviate perioperative anxiety, depression and psychological stress reaction, whose effect is satisfactory and worthy of clinical application.
Objective To investigate the effect of enhanced recovery after surgery(ERAS) on prognosis, negative emotion and psychological stress in patients with undergoing laparoscopic radical resection of gastric carcinoma. Method 130 patients underwent laparoscopic radical resection of gastric carcinoma in Tongling People's Hospital from January 2015 to December 2017 were enrolled for the study and divided into observation group and control group according to random number table method, 65 cases in each group. Patients in control group were given traditional perioperative intervention, patients in observation group were given ERAS comprehensive intervention. The postoperative recovery indexes, scores of Hamilton depression scale(HAMD), Hamilton anxiety scale(HAMA) and stress response questionnaire(SRQ) were compared between two groups at different time points. Result All patients successfully completed laparoscopic radical resection of gastric carcinoma. The first exhaust time, first eating time, time of beginning get out of bed, stomach tube extubation time, postoperative hospitalization days in observation group were significantly shorter than those in control group(P_(all)< 0.05). The scores of HAMA, HAMD and all dimensions of SRQ at 1 hour before operation and 48 hours after operation in observation group were significantly lower than those at hospitalization(P_(all)< 0.05), while somatic reaction score of SRQ at 1 hour before operation, scores of HAMA, HAMD and all dimensions of SRQ at 48 hours after operation in control group were significantly lower than those at hospitalization(P_(all)< 0.05). The scores of HAMA, HAMD and all dimensions of SRQ at 1 hour before operation and 48 hours after operation in observation group were significantly lower than those in control group at the same time(P_(all)< 0.05). Conclusion ERAS can significantly promote the recovery of gastrointestinal function and improve prognosis in patients with gastric cancer undergoing laparoscopic radical resection of gastric carcinoma, and it also can significantly alleviate perioperative anxiety, depression and psychological stress reaction, whose effect is satisfactory and worthy of clinical application.
引文
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[9]刘晓飞,李方正,张庆凤,等.加速康复外科在腹腔镜下肾部分切除术中的应用[J].中国医学前沿杂志(电子版),2017,9(7):20-23.
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[11]陈晓鹏,王东,崔巍,等.加速康复外科联合腹腔镜胆总管探查术治疗胆总管结石的前瞻性研究[J].中华消化外科杂志,2015,14(1):47-51.
[12]肖二卫,王连才,王亚峰,等.加速康复外科在腹腔镜联合胆道镜治疗胆囊结石合并肝外胆管结石中的应用[J].中华普通外科杂志,2018,33(5):408-411.
[13]Kehlet H.Enhanced recovery after surgery(ERAS):Good for now,but what about the future?[J].Can J Anaesth,2015,62(2):99-104.
[14]徐幸,徐钧.加速康复外科在腹腔镜辅助远端胃癌根治术中的应用[J].肿瘤研究与临床,2017,29(3):180-183.
[15]李益萍,邱江锋,曹晖,等.加速康复外科在腹腔镜胃癌根治术围手术期中的应用[J].中华胃肠外科杂志,2016,19(3):269-273.
[16]赵洪霞,程艳,刘海燕,等.应用加速康复外科护理对腹腔镜胃癌根治术患者预后的影响[J].转化医学电子杂志,2015,(8):144-146.
[17]Kim JW,Kim WS,Cheong JH,et al.Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer:a randomized clinical trial[J].World J Surg,2012,36(12):2879-2887.
[18]张淑珍,刘玉海,吕杰,等.体感振动音乐疗法结合超反射脑磁治疗仪治疗卒中后抑郁疗效观察[J].转化医学电子杂志,2014,(6):122-123.
[19]解芙艳,马艳华,高娃,等.社区老年慢性病患者的抑郁状况及其对抑郁情绪认知情况的调查[J].转化医学电子杂志,2015,2(10):46-47.
[20]Barringer LB,Evans CW,Ingram LL,et al.Agreement between temporal artery,oral,and axillary temperature measurements in the perioperative period[J].J Perianesth Nurs,2011,26(3):143-150.
[2]Nygren J,Thacker J,Carli F.Guidelines for perioperative care in elective rectal/pelvic surgery:Enhanced recovery after surgery(ERAS)society recommendations[J].Clin Nutr,2012,31(6):801-816.
[3]Mortensen K,Nilsson M,Slim K.Consensus guidelines for enhanced recovery after gastrectomy:Enhanced recovery after surgery(ERAS)society recommendations[J].Br J Surg,2014,101(10):1209-1229.
[4]Lassen K,Coolsen MM,Slim K.Guidelines for perioperative care for pancreaticoduodenectomy:Enhanced recovery after surgery(ERAS)society recommendations[J].Clin Nutr,2012,3(6):817-830.
[5]Mortensen K,Nilsson M,Slim K,et al.Guidelines for perioperative care in elective colonic surgery:Enhanced recovery after surgery(ERAS)society recommendations[J].Clin Nutr,2012,31(6):783-800.
[6]庄桂敏,于鲁欣,董利英,等.加速康复外科在经皮肾镜取石术中的应用[J].中国医学前沿杂志(电子版),2017,9(7):12-15.
[7]Wind J,Po He SW,Fung KJ,et al.Systematic review of en-6enhanced recovery programmes in colonic surgery[J].Br JSury,2009,93(7):800-809.
[8]胡友伦,赵然楚.加速康复外科理念在腹腔镜下结直肠癌根治术中的应用[J].临床医学,2018,38(6):59-61.
[9]刘晓飞,李方正,张庆凤,等.加速康复外科在腹腔镜下肾部分切除术中的应用[J].中国医学前沿杂志(电子版),2017,9(7):20-23.
[10]张其强,赵海卫,张学宝,等.加速康复外科在后腹腔镜肾上腺切除术中的应用[J].国际泌尿系统杂志,2018,38(5):785-788.
[11]陈晓鹏,王东,崔巍,等.加速康复外科联合腹腔镜胆总管探查术治疗胆总管结石的前瞻性研究[J].中华消化外科杂志,2015,14(1):47-51.
[12]肖二卫,王连才,王亚峰,等.加速康复外科在腹腔镜联合胆道镜治疗胆囊结石合并肝外胆管结石中的应用[J].中华普通外科杂志,2018,33(5):408-411.
[13]Kehlet H.Enhanced recovery after surgery(ERAS):Good for now,but what about the future?[J].Can J Anaesth,2015,62(2):99-104.
[14]徐幸,徐钧.加速康复外科在腹腔镜辅助远端胃癌根治术中的应用[J].肿瘤研究与临床,2017,29(3):180-183.
[15]李益萍,邱江锋,曹晖,等.加速康复外科在腹腔镜胃癌根治术围手术期中的应用[J].中华胃肠外科杂志,2016,19(3):269-273.
[16]赵洪霞,程艳,刘海燕,等.应用加速康复外科护理对腹腔镜胃癌根治术患者预后的影响[J].转化医学电子杂志,2015,(8):144-146.
[17]Kim JW,Kim WS,Cheong JH,et al.Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer:a randomized clinical trial[J].World J Surg,2012,36(12):2879-2887.
[18]张淑珍,刘玉海,吕杰,等.体感振动音乐疗法结合超反射脑磁治疗仪治疗卒中后抑郁疗效观察[J].转化医学电子杂志,2014,(6):122-123.
[19]解芙艳,马艳华,高娃,等.社区老年慢性病患者的抑郁状况及其对抑郁情绪认知情况的调查[J].转化医学电子杂志,2015,2(10):46-47.
[20]Barringer LB,Evans CW,Ingram LL,et al.Agreement between temporal artery,oral,and axillary temperature measurements in the perioperative period[J].J Perianesth Nurs,2011,26(3):143-150.
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