Effect Of Enhanced Recovery After Surgery On Postoperative Recovery And Immune Function Of Patients Undergoing Esophageal Cancer

ObjectiveTo oberve the effect of enhanced recovery after surgery(ERAS)on the recovery and immune function of patients undergoing esophageal cancer.MethodsFrom January 2018 to September 2018,78 patients with esophageal cancer who underwent thoracotomy in the Department of Cardiothoracic Surgery,the Second Affiliated Hospital of Zhengzhou University,were selected.Among them,18 cases were screened out for various reasons:such as severe immune system diseases,obvious cardiopulmonary dysfunction,patients and family rejection,obesity,etc.60 patients with esophageal cancer were selected,and were randomly divided into the conventional group(N group)and ERAS group(group E),30 cases in each group.Patients in group E accepted perioperative and anaesthetic optimization of enhanced recovery after surgery pathway,and patients in group N recived perioperative and anaesthetic management of normal surgery concept.The volume of fluid and bleeding,the total amount of sufentanil,the nasopharyngeal temperature,the time of chest tube extraction,were recorded in two groups.Visual analogue scales(VAS)scores were recorded2h,6h,12h,24h,48h postoperatively were recorded at rest and cough.Postoperative adverse reactions such as nausea,vomiting,restlessness,chills,urinary retention,intestinal obstruction and pulmonary infection were recorded.The time of PACU after surgery,the total days of hospitalization and total hospital costs were recorded.Furthermore,Blood samples were obtained at one day before operation(T0),at the end of operation(T1)?one day after operation(T2),three days and seven days(T3-4)after operation for determination of plasma concentration of IgA,IgM,IgG and the percentages of T lymphocyte subsets(CD3+?CD4+?CD8+)and CD4+/CD8+ratio were detected with flow cytometry.Results1.There were no statistically significant differences between the two groups in gender,age,ASA classification,BMI,and re-hospitalization within 3 months(P>0.05).The postoperative PACU residence time and total hospitalization time in group E were significantly shorter than those in group N,and the total hospitalization cost in group E was significantly lower than that in group N(P<0.05).2.There were no statistically significant differences between the two groups in terms of operation time and blood loss(P>0.05).The total amount of fluid rehydration and sufentanil in group E was significantly lower than that in group N(P<0.05).3.The nasopharyngeal temperature of patients in group E was higher than that in group N(P<0.05)1h after anesthesia,at the end of surgery,and before returning to the ward.4.Compared with group N,patients in group E had lower VAS pain scores at 2h,6h,12h and 24h after surgery both at rest and cough(P<0.05).There was no significant difference in VAS score between the two groups at rest and cough 48h after surgery(P>0.05).5.Compared with group N,the time of first exhaust,the first time of get out of bed and the time to retain thoracic tube were significantly shorter in group E(P<0.05).6.The incidence of postoperative adverse reactions such as nausea and vomiting,agitation,skin itching and chillness in group E was significantly lower than that in group N(P<0.05),and there was no statistically significant difference in the incidence of urinary retention,intestinal obstruction and pulmonary infection between the two groups(P>0.05).7.Compared with T0,the plasma concentration of IgA,IgM,IgG and the percentages of CD3+?CD4+?CD8+and CD4+/CD8+ratio in group E on T1-3 were significantly decreased,the plasma concentration of IgA,IgM,IgG and the percentages of CD3+?CD4+?CD8+and CD4+/CD8+ratio in group N on T1-4 were significantly decrease(P<0.05).Compared with group N,the plasma concentration of IgA,IgM,IgG and the percentages of CD3+?CD4+?CD8+and CD4+/CD8+ratio in group E on T1-4 were significantly increased(P<0.05).ConclusionEnhanced recovery after surgery pathway can not only reduce the total length of cost of hospitalization,but also promote the postoperative recovery of patients undergoing radical resection of esophageal cancer.Enhanced recovery after surgery pathway is helpful in improving immune function of patients undergoing esophageal cancer to some extent.