Effect of enhanced recovery after surgery on the surgical treatment of patients with radiation enteritis and intestinal obstruction / 中国综合临床

ABSTRACT

Objective:To investigate the effect of enhanced recovery after surgery (ERAS) on the surgical treatment of radiation enteritis with intestinal obstruction.Methods:A total of 80 patients with radiation enteritis and intestinal obstruction admitted to the Department of General Surgery, the Eighth Center of Chinese PLA General Hospital from June 2015 to December 2019 were selected and divided into observation group and control group according to the principle of baseline feature matching, with 40 cases in each group.Fourty cases in the control group received conventional surgical treatment combined with conventional rehabilitation intervention, while 40 cases in the observation group received conventional surgical treatment combined with ERAS intervention.According to hemoglobin (HGB), albumin (ALB), prealbumin (PA), transferrin (TRF), the nutritional status of patients in the two groups was compared before and after intervention.According to interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), hypersensitivity C-reactive protein (hs- CRP), tumor necrosis factor-α (TNF-α), the changes of inflammatory factors in the two groups was compared before and after intervention.The immunoglobulin (Ig) A, G and M of the two groups was compared before and after intervention.The postoperative recovery and the incidence of postoperative complications was observed in the two groups.Results:After the intervention, the level of HGB(125.56±11.18) g/L, ALB(42.46±3.95) g/L, PA(0.28±0.03) g/L and TRF(2.60±0.30) g/L in the observation group was higher than that in the control group (102.95±11.12), (36.28±4.25), (0.20±0.05), (2.09±0.27) g/L, respectively, and the differences between the two groups were significant (all P<0.001). After the intervention, the level of IL-2(3.69±0.79) ng/L, IL-6(15.79±7.17) ng/L, IL-8(6.24±1.25) ng/L, hs-CRP(12.51±2.34) ng/L, TNF-α(1.51±0.68) μg/L in the observation group was lower than that in the control group(7.26±1.23) ng/L, (23.82±6.95) ng/L, (9.13±1.71) ng/L, (17.63±2.27) ng/L, (2.02±0.81) μg/L, respectively, and the differences between the two groups were significant ( P<0.001, P<0.001, P<0.001, P<0.001, P=0.003). After the intervention, the level of IgA(1.92±0.63) g/L, IgG(11.36±1.26) g/L, IgM(2.01±0.57) g/L in the observation group was higher than that in the control group (1.62±0.49), (9.58±1.23), (1.60±0.47) g/L, respectively, and the differences between the two groups were significant ( P=0.020, <0.001, =0.001, respectively). In the observation group, the hospital stay(12.1±1.7) d, postoperative ambulation time (1.9±0.6) d and exhaust time (3.1±0.4) d was less than that in the control group(17.2±2.4) d, (2.8±1.0) d, (4.2±0.8) d, respectively, and there were significant differences between two groups(all P<0.001). The postoperative complication rate of 5.0%(2/40) in the observation group was significantly lower than 25.0%(10/40) in the control group (χ 2=6.275, P=0.012). Conclusion:The patients with radiation enteritis and intestinal obstruction treated by conventional surgery were given eras intervention, which improved the nutritional level, immune function and inflammatory stress reaction of the patients, improved the treatment effect of the patients, and shortened the hospitalization time.