| [Objective] postoperative ileus, occurres in virtually all abdominal surgery, causing patients to eat delays, malnutrition, increased infectious complications, prolonged hospital stay, increased hospital costs, decreased quality of life. But there is no effective way to prevent postoperative ileus, and also the lack of a systematic treatment regimen for postoperative ileus of the mechanism, the present study was designed to assess whether the gastrointestinal rapid rehabilitation can improve patients after major surgery in the abdomen postoperative ileus, clinical outcomes, reduce costs, improve quality of life.[Methods] Second Affiliated Hospital of Yunnan Province, Kunming Medical University gastrointestinal surgery two wards in December 2014-100 patients in October 2015 of undergoing major surgery of the abdomen were randomly divided into rehabilitation group and gastrointestinal fast conventional therapy group. Gastrointestinal rapid rehabilitation group were to (1) increase measures to stimulate appetite and gastrointestinal motility patient. comprising:Watch videos related to food; placing the patient ward favorite fruits and food, so that it can always see and smell the fruit and the smell of food; accompanying persons into the patient bedside meals. (2) chewing gum. (3) Early enteral nutrition (4) early ambulation. (5) the early-removal of the tube. Traditional treatment group forbidden to drink fasting to vent, rear vent tube removed, according to the wishes of the patient own activities. Compared two groups of gastrointestinal function recovery time, clinical outcomes, hospital costs and postoperative quality of life.[Results]1. The recovery time of gastrointestinal function:Gastrointestinal rapid rehabilitation group compared with the conventional treatment group, (1) after the first breather ahead of time (46.47 ± 17.37h VS 59.63 ± 13.89h); (2) after the first bowel movement ahead of time (68.73 ± 17.76h VS 78.63 ± 15.47h); (3) after oral consumption amounted to 60% of the requirements ahead of time (4.31 ±1.38d VS 6.22 ± 0.99 d); differences were statistically significant (P<0.05).2. Clinical Laboratory:(1) C-reactive protein (C reaction proteins, CRP) mg/L Within groups:two groups of CRP values were significantly increased in the first postoperative day; 4 days after rising; the first seven days after the fall, but still higher than the preoperative level; the differences were statistically significant (P< 0.05). Between the two groups:GI rapid rehabilitation group compared with conventional therapy, stress less, after the first day of 1,4,7 CRP values were lower than the conventional treatment group (5.11 ± 0.32 VS 7.25 ± 0.17,3.52 ± 1.14 VS 6.57 ± 0.95, 2.09 ± 1.69 VS 4.40 ± 1.69), the differences were statistically significant (P<0.05).(2) plasma endotoxin (Endotoxin, Et) (EU/ml): Within the group:1,4,7 day postoperative significantly increased plasma endotoxin compared with preoperative, the difference was statistically significant (P<0.05). Between the two groups:GI rapid rehabilitation after the first day than the traditional treatment group no significant difference (P> 0.05), after the first day 4,7 lower conventional treatment group (0.47 ± 0.19 VS 0.56 ± 0.17,0.39 ± 0.22 VS 0.52 ± 0.18), the difference was statistically significant (P<0.05).(3) liver function indicators: ①alanine aminotransferase (Alanine aminotransferase, ALT) Within the group:ALT value decreased in both groups after the first day; the fourth postoperative day,7 days after continuous decline, significantly lower than the preoperative level; differences were statistically significant (P<0.05). Between the two groups:GI rapid rehabilitation therapy compared with conventional therapy group,1,4,7 days after surgery were not statistically different (P> 0.05). ② alkaline phosphatase (Alkaline phosphatase, ALP) Within the group:two ALP value of postoperative day 1 compared with preoperative decreased on day 4, day 7 continued to decline, the difference was statistically significant (P<0.05).Between the two groups:GI rapid rehabilitation therapy compared with conventional therapy group,1,4,7 days after surgery were not statistically different (P> 0.05). ③ total bilirubin (Total bilirubin, TBIL) Within groups:two groups preoperative TBIL value after the first day and there was no significant difference (P> 0.05); postoperative days 4,7 were lower compared with preoperative differences were statistically significant (P< 0.05). Between the two groups:GI rapid rehabilitation therapy compared with conventional therapy group,1,4,7 days after surgery were not statistically different (P> 0.05). ④ prealbumin (Prealbumin, PA) Group comparison:PA values in both groups declined in the first postoperative day; the first four days after the rebound, after the first seven days continued to rise, but still lower than the preoperative level; Between the two groups:GI rapid rehabilitation therapy compared with conventional therapy group,1,4,7 days after surgery were not statistically different (P> 0.05).3. the incidence of complications:gastrointestinal rapid rehabilitation therapy compared with conventional therapy, infection-related complications (11.76% VS 32.65%) and non-infectious complications (1.9% VS 7.4%) lower incidence, the difference there was statistically significant (P<0.05). The incidence of gastrointestinal complications was no significant difference (P> 0.05).4.Length of stay:gastrointestinal rapid rehabilitation therapy compared with conventional therapy, nutrition hospital stay (9.26 ± 5.21d VS 11.63 ± 4.13d), postoperative hospital stay (10.64 ± 3.58d VS 13.45 ± 4.70d). total hospitalization time (16.22 ± 6.50d VS 18.53 ± 5.53d) were shortened, the difference was statistically significant (P<0.05).5.Cost:Gastrointestinal rapid rehabilitation therapy compared with conventional therapy, nutritional support costs (2314.26(1620.53,2955.8) Yuan VS 3721.54(1727.57,3951.7) Yuan), infectious complications fee (1045.34(921.87,1683.44) Yuan VS 5689.34(2018.87,7683.44) Yuan) and the total cost of hospitalization (29476.17(15723.01,48765.46) Yuan) VS (332854.26(16754.1,58241.66) Yuan) were lower, the difference was statistically significant (P<0.05).6. Quality of Life:Within groups:the postoperative day 2,3,5,7,10,14 preoperative QOL value ratio decreased over time in both groups QOL values gradually increase, the difference was statistically significant (P< 0.05); after the postoperative day 28 days no significant difference (P> 0.05) before operation.. Between the two groups:on the postoperative day five time points 3,5,7,10,14, gastrointestinal rapid rehabilitation group QOL were higher than the conventional treatment group, the difference was statistically significant (P<0.05). After 2 days and 28 days no significant difference (P> 0.05).[Conclusion] gastrointestinal rapid rehabilitation program for the pathogenesis of postoperative ileus after major surgery in the abdomen is safe to use for improving postoperative ileus is effective. Compared with traditional treatment programs, can shorten the time to recovery of gastrointestinal function and reduce postoperative stress, improve clinical outcomes, thus shortening the length of hospital stay, hospital costs savings and improve quality of life after surgery, should be promoted in clinical practice. |
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