结直肠肛门外科2025，Vol.31Issue(3)：237-244,8.DOI:10.19668/j.cnki.issn1674-0491.2025.03.010
结直肠癌术后短期应用甲泼尼龙联合多模式镇痛对肠功能恢复的影响
Impact of short-term application of methylprednisolone combined with multimodal analge-sia on intestinal function recovery after colorectal cancer surgery
摘要
Abstract
Objectives To investigate the impact of short-term application of methylprednisolone combined with multi-modal analgesia on intestinal function recovery after colorectal cancer surgery.Methods A total of 78 patients who under-went radical colorectal cancer surgery at the Department of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine from March 2022 to December 2024 were randomly divided into an observation group(adopting the methylprednisolone combined with multimodal analgesic regimen of flurbiprofen axetil+paracetamol tramadol)and a con-trol group(adopting the multimodal analgesic regimen of flurbiprofen axetil+paracetamol tramadol).Each group consisted of 39 cases.The postoperative recovery indicators(the time of postoperative first flatus,the time of tolerating semi-liquid diet,the time of stopping intravenous fluid administration after surgery,the time of retaining the drainage tube af-ter surgery,the postoperative hospital stay),postoperative incision pain degree(assessed by visual analogue scale),the heart rate variability parameters(standard deviation of RR intervals in sinus rhythm,the percentage of the number of ad-jacent RR intervals greater than 50 ms,low-frequency power,high-frequency power,low-frequency power/high-frequency power),inflammatory markers(high-sensitivity C-reactive protein,interleukin-2,interleukin-6,interleukin-1 β,tumor necro-sis factor-α,gamma interferon),and the occurrence of postoperative complications were compared between the two groups.Results Compared with the control group,the observation group had shorter postoperative first flatus time,time to tolerate semi-liquid diet,and postoperative hospital stay(P＜0.05);there was no statistically significant difference in the time to stop intravenous fluid administration and the time to retain the drainage tube after surgery between the two groups(P＞0.05).The postoperative incision pain score of the observation group was lower than that of the control group,and the difference was statistically significant(Wald x2=6.799,P=0.009).With the passage of time,the postopera-tive incision pain score of patients showed a downward trend(Wald x2=77.242,P＜0.001).The postoperative incision pain score on the first day of the observation group was lower than that of the control group(P=0.001),and there was no statistically significant difference between the two groups on the second and third days after surgery(P＞0.05).On the first day after surgery,there was no statistically significant difference in the comparison of hypersensitive C-reactive protein,interleukin-2,interleukin-6,interleukin-1β,tumor necrosis factor-α,and gamma interferon between the two groups(P＞0.05).On the third day after surgery,the hypersensitive C-reactive protein,interleukin-2,and interleukin-6 of the observation group were lower than those on the first day,and the hypersensitive C-reactive protein and interleu-kin-6 of the observation group were lower than those of the control group(P＜0.05).On the first day after surgery,there was no statistically significant difference in the comparison of standard deviation of sinus rhythm RR interval,the percentage of adjacent RR intervals greater than 50 ms,low-frequency power,high-frequency power,and the ratio of low-frequency power to high-frequency power between the two groups(P＞0.05).On the third day after surgery,the stan-dard deviation of sinus rhythm RR interval,the percentage of adjacent RR intervals greater than 50 ms,low-frequency power,and high-frequency power of the observation group were higher than those on the first day;the high-frequency power of the observation group was higher than that of the control group,and the percentage of adjacent RR intervals greater than 50 ms and high-frequency power of the observation group were higher than those of the control group(P＜0.05).There was no statistically significant difference in the incidence of complications such as anastomotic leakage,ab-dominal infection,postoperative bleeding,postoperative intestinal paralysis,incision infection,pulmonary infection,deep vein thrombosis of the lower extremities,aspiration pneumonia,etc.between the two groups(observation group 46.2％vs.control group 41.0％;x2=1.450,P=0.821).Conclusion Short-term application of methylprednisolone combined with multimodal analgesia after colorectal cancer surgery is safe and effective.It may achieve this by inhibiting inflammatory responses,regulating autonomic nerve function,and promoting intestinal function recovery.关键词
结直肠癌/甲泼尼龙/加速康复外科/肠功能Key words
colorectal cancer/methylprednisolone/enhanced recovery after surgery/intestinal function分类
医药卫生引用本文复制引用
王烨,王刚,李昊洋,葛苗苗,南海鸥,张天乐,夏露露,王海锋,江志伟..结直肠癌术后短期应用甲泼尼龙联合多模式镇痛对肠功能恢复的影响[J].结直肠肛门外科,2025,31(3):237-244,8.基金项目
2022重大科学攻关问题和医药技术难题(2022KTZ005) （2022KTZ005）
江苏省中医药学会振兴发展项目(ZXFZ2024001) （ZXFZ2024001）
