| Objective:The safety as well as effectiveness of enhanced recovery after surgery(ERAS)in patients with gastric cancer and type 2 diabetes mellitus(T2DM-GC)have been verified by evidence-based medicine,on the basis of previous research,this study aims to analyze the effects of ERAS concept on postoperative stress as well as coagulation function in patients with T2DM-GC.Methods:From January 2022 to August 2022,57 patients with T2DM-GC were selected.Among them,29patients(17 males and 12 females)entered the ERAS concept clinical pathway,and 28 patients(15 males and 13 females)did not enter the ERAS concept clinical pathway.The relevant indicators were explored,including general data of patients: age,gender,BMI index,ASA classification,NRS2002 score,surgical method and operation duration,intraoperative blood loss,lymph node dissection,tumor TNM staging.Blood glucose levels: fasting blood glucose on admission,2 days before surgery,1 day before surgery,the morning of surgery day,and 1 to 7 days after surgery;blood glucose levels at the beginning of surgery,1 hour during surgery,2 hours during surgery,3 hours during surgery,and the end of surgery;Inflammatory stress-related indicators: CRP,WBC,IL-1β,IL-4,IL-6;Coagulation related indicators:PT,APTT,TT,FIB,Ddimer.Results:There was no significant difference in clinical data between the two groups of patients before surgery(P>0.05).In addition,there was no significant difference in clinical data between the two groups of patients during and after surgery(P>0.05).At the time of surgery and before the start of surgery,there was no significant difference(P>0.05)in the fasting blood glucose measured in the morning between the two groups of patients.However,after surgery,blood glucose levels in both groups increased to varying degrees,but the ERAS group had a lower average and a more stable trend compared to the non ERAS group.Postoperative blood glucose levels were observed on the 1st,3rd,and 5th day after surgery On the 7th day after surgery,the differences were statistically significant(P<0.05).The intraoperative blood glucose levels of both groups of patients showed a trend of first increasing and then decreasing.However,the ERAS group had a lower average intraoperative blood glucose level compared to non ERAS group patients and the trend was relatively stable.The differences in intraoperative blood glucose levels at 1 hour,2 hours,and 3 hours were statistically significant(P<0.05).In terms of postoperative stress,both groups of patients had preoperative CRP,white blood cell count,and IL-1 levels β、 The difference in IL-4 and IL-6 was not statistically significant(P>0.05),and both showed a trend of first increasing and then decreasing after surgery.However,the mean intraoperative blood glucose levels of ERAS group patients were lower and the trend was relatively stable compared to non ERAS group patients.The CRP levels of ERAS group patients were on the 5th and 7th days after surgery,white blood cell counts were on the 3rd and 5th days,and IL-1 was observedβ On the 3rd day,IL-4 showed significant differences in levels compared to the control group patients on the 1st and 3rd day,and IL-6 on the 3rd and 5th day after surgery(P<0.05).In terms of coagulation function,the ERAS group showed significant differences in PT levels on the 5th day,TT levels on the 3rd and 5th day,FIB levels on the 3rd,5th and 7th day after surgery,and D-dimer levels on the 3rd and 5th day after surgery compared to the control group(P<0.05).There was no significant difference in APTT levels between the two groups of patients(P>0.05).In addition,in the comparison of postoperative nutritional status between the two groups of patients,the ERAS group had statistically significant differences in hemoglobin on the 3rd day after surgery,albumin on the 3rd and 5th day after surgery,and lymphocytes on the 3rd and 5th day after surgery compared to non ERAS group patients(P<0.05).Finally,both groups of patients showed significant improvement in postoperative recovery compared to the control group.Conclusion:ERAS treatment can effectively improve the coagulation function of gastric cancer patients with type 2 diabetes,inhibit postoperative inflammatory reaction,improve the prognosis and reduce complications,and reduce the length of stay of patients. |
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