| Objective :To investigate the effect of Multiple factors and methods of promoting intestinal recovery on postoperative ileus(POI),and investigate nutritional status 、humoral immune function、inflammatory mediators and clinical outcome after Improved POI in colorectal cancer patients. To find effective ways to promote postoperative recovery of patients with colorectal cancer and provide the best solution for clinical treatment.Methods: Fifty-nine patients from Second Affiliated Hospital of Yunnan Province,Kunming Medical University gastrointestinal surgery in January to November 2016 with laparoscopic colorectal surgery were prospectively enrolled and randomized into two groups: gastrointestinal rapid rehabilitation group(treatment group n=30) and control group(n=29). treatment group were to 1. To promote the recovery of intestinal function by increasing the nerve reflex with stimulating the patient’s vision、smell、taste、auditory;comprising:playing videos related to patient favorite food,placing the patient ward favorite fiuits ,watching others eating and oral vitamin C . 2. To promote the recovery of intestinal function by chewing and swallowing reflex with chewing gum; 3. To promote the recovery of intestinal function with oral administration and early enteral nutrition; 4. To promote the recover of intestinal function with early ambulation. Control group: giving enteral nutrition after exhaust and defecation,according to the wishes of the patient own activities. POI、nutritional status(prealbumin、body weight loss、loss of fat mass、loss of fat free mass)、humoral immune function(IgG、IgA、IgM、C3、C4)、inflammatory mediators (IL-6、TNF)and clinical outcome(the incidence of complications、the postoperative hospital stay、cost) were compared between two groups.Results: Fifty-nine patients completed the study, , including 30 cases in the treatment group and 29 cases in the control group.1.The incidence of POI was less than the control group after the intervention group, and the difference was statistically significant(P<0.05).2. Nutritional status(1) Prealbumin: the concentrations of prealbumin were decreased after operation and then restored gradually in two groups. there was no significant difference of the concentrations of prealbumin the first postoperative day and preoperative level in two groups (P > 0.05) ; the concentrations of prealbumin in the third and seventh postoperative day in the treatment group were higher than those in the control group(P<0.05)(2) Weight were lost after operation in two groups,loss of fat free mass was the vast proportion of body weight loss. Body weight loss、loss of fat mass and loss of fat free mass in the seventh postoperative day in the treatment group were not statistically different those in the control group(P>0.05).3. Humoral immune functionThe levels of humoral immune function were elevated after operation and then decreased gradually in two groups. The levels of IgG were obviously higher in the treatment group as compared to control group(P<0.05).4. Inflammatory mediators(1)IL-6Within the group: the concentrations of IL-6 were elevated after operation.The concentrations of IL-6 in the first and third postoperative day in the treatment group were higher than those in the preoperative level, the differences were statistically significant(P < 0.05). However there was not significant difference in the seventh postoperative day. The concentrations of IL-6 in the first、third、seventh postoperative day in the control group were higher than those in the preoperative level (P<0.05).Between the two groups: there was no significant difference between the first postoperative day and the preoperative day in two groups about IL-6. Compared with control group, the concentrations of IL-6 were lower in the third and seventh postoperative day in the treatment group(P <0.05).(2)TNF-aWithin the group: the concentrations of TNF-awere elevated after operation. The concentrations of TNF-ain the first and third postoperative day were higher than those before operation in the treatment group (P< 0.05); there was no significant difference of the concentrations of TNF-ain the seventh postoperative day(P > 0.05). The concentrations of TNF-α in the first、third、seventh postoperative day in the control group were higher than those in the preoperative level (P<0.05).Between the two groups: there was no significant difference of the concentrations of TNF-a in the first and the seventh postoperative day in two groups (P > 0.05). The concentrations of TNF-αin the third postoperative day were obviously lower in the treatment group as compared to control group(P<0.05).5. The postoperative hospital stayThe postoperative hospital stay were obviously shorter in the treatment group as compared to control group(P<0.05).6.CostThe treatment group compared with control group, the costs were lower, the difference was statistically significant (P <0.05).7. The incidence of complicationsThere was no significant difference of the incidence of abdominal distension、vomiting、diarrhea、pneumonia、anastomotic leakage、SIRS and placing gastric tube(P>0.05).Conclusion: Gastrointestinal rapid rehabilitation can lead to faster recovery of POI、improve nutritional status、reduce inflammatory reaction、shorten the length of hospital stay and cut down cost. And it does not increase the incidence of complications and should be promoted in clinical practice. |
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