Enhanced Recovery After Surgery (ERAS) Program Attenuates Stress and Accelerates Recovery in Patients After Radical Resection for Colorectal Cancer: A Prospective Randomized Controlled Trial
Enhanced Recovery After Surgery (ERAS) Program Attenuates Stress and Accelerates Recovery in Patients After Radical Resection for Colorectal Cancer: A Prospective Randomized Controlled Trial
复制标题
加速康复外科 (ERAS) 计划减轻结直肠癌根治性切除术后患者的压力并加速康复：一项前瞻性随机对照试验
DOI：
10.1007/s00268-011-1348-4
复制
发表时间：
2012-02-01
影响因子：
2.6
通讯作者：
Wu, Zhaoguang
中科院分区：
文献类型：
--
作者：
Ren, Li;Zhu, Dexiang;Wu, Zhaoguang
AbstractBackgroundThe的目的是比较增强术后恢复（ERAS）程序与传统的围手术期管理的患者接受根治性切除术的结直肠cancer.MethodsA相结合的证据为基础的共识的方法被用来开发ERAS协议。597例接受择期结直肠切除术的连续患者被随机分配至ERAS组（n= 299）或对照组（n= 298）。结果有关营养和代谢指数，压力指数，恢复指数进行了测量和recorded.ResultsDemographic和手术数据两组之间是相似的。与对照组相比，ERAS组患者的营养状况有所改善。术后第1天，ERAS组的HOMA-IR（胰岛素抵抗指数）低于对照组（p< 0.001）。与术前水平相比，对照组的皮质醇水平在POD 1（p= 0.007）和POD 5（p= 0.002）均升高。然而，ERAS组的皮质醇水平直到POD 5才增加（p= 0.001）。ERAS组中TNF-α、IL-1β、IL-6和IFN-γ水平降低表明术后应激反应较少。此外，ERAS与胃肠道功能的加速恢复有关。与对照组相比，ERAS组的术后住院时间（p< 0.001）和费用（p< 0.001）减少。对照组28例，ERAS组29例出现并发症，无显著差异。结论ERAS方案减轻了手术应激反应，加快了术后恢复，而不影响患者安全。
AbstractBackgroundThe aim of this trial was to compare the Enhanced Recovery After Surgery (ERAS) program with conventional perioperative management in patients who underwent radical resection for colorectal cancer.MethodsA combination of evidence‐based and consensus methodology was used to develop the ERAS protocol. Five hundred ninety‐seven consecutive patients who underwent elective colorectal resection were randomized to either the ERAS (n= 299) or the control group (n= 298). Outcomes relating to nutrition and metabolism index, stress index, and recovery index were measured and recorded.ResultsDemographic and operative data were similar between the two groups. Patients in the ERAS group showed improved nutritional status when compared with those of the control group. On postoperative day (POD) 1, the HOMA‐IR (insulin resistance index) of the ERAS group was lower than that of the control group (p< 0.001). The cortisol level of the control group was elevated on both POD 1 (p= 0.007) and POD 5 (p= 0.002) compared to the preoperative level. However, the cortisol level of the ERAS group was not increased until POD 5 (p= 0.001). Reduced levels of TNF‐α, IL‐1β, IL‐6, and IFN‐γ in the ERAS group indicated less postoperative stress responses. In addition, ERAS was associated with accelerated recovery of gastrointestinal function. The postoperative length of stay (p< 0.001) and expense (p< 0.001) for the ERAS group were reduced in comparison to the controls. Twenty‐eight cases in the control group and twenty‐nine in the ERAS group suffered complications, which was not significantly different.ConclusionThe ERAS protocol attenuates the surgical stress response and accelerates postoperative recovery without compromising patient safety.