Eating Time, Transfusion Control And Pain Relief On Postoperative Recovery Of Patients With Hepatobiliary Disease

Objective:Investigate impact of time shortening of the preoperative diet, intraoperative and postoperative transfusion control, postoperative pain relief, early postoperative feeding on patients with the hepatobiliary disease about length of stay, postoperative passage of gas by anus, complications, weight loss, treatment cost, inflammatory mediators and the intestinal barrier function. Provide the theoretical basis for clinical to speed up the patients'rehabilitation of hepatobiliary disease.Methods:From June to December in 2009,40 cases by hepatobiliary surgery were choosen from Second Affiliated Hospital of Kunming Medical College, including 20 cases of cholecystectomy patients,10 cases of patients with bile duct exploration,10 cases of patients undergoing hepatectomy. All patients were randomly divided into experimental group of fast-track surgery and conventional control group. Experimental group had 20 cases.(10 cases with cholecystectomy,5 cases with bile duct exploration,5 cases undergoing hepatectomy). To the objects, perform preoperative fasting for 6 hours, serving of 10% glucose 500ml 2 hours preoperatively, intraoperative and postoperative transfusion with daily limit of 35ml/kg for 3 or 4 days before normal diet, useing the postoperative continuous epidural analgesia by bupivacaine or ropivacaine for 24 to 48 hours and having a certain amount of liquid diet 6h after operation. Normal control group had 20 cases. To the objects, perform preoperative fasting for 12h and drinking forbidden for 4h, routine intraoperative and postoperative transfusion without specific control, postoperative relief by opioid analgesics,eating after the postoperative flatus. Collected peripheral blood samples at 24 hours before surgery, after the postoperative 24h and 96h after operation respectively and detected expression of C-reactive protein, insulin, blood glucose, tumor necrosis factor, interleukin-6, cortisol, albumin. Collected peripheral blood at 24h before surgery and 24 after operation and then detected expression of plasma D-lactate. Recorded length of stay, time of postoperative passage of gas by anus, treatment costs, weight loss after surgery (weighed daily, preoperatively and postoperatively) and abdominal pain, diarrhea, infections, aspiration and other complications.Results:1. Changes in hematological indices in both groups:Postoperative blood glucose concentration, insulin, cortisol, C-reactive protein, tumor necrosis factor-a were increased, the maximum postoperative 24 hours,96 hours has been reduced, still higher than preoperative. Postoperative 24 hours,96 hours in the experimental group, glucose, insulin, cortisol, C-reactive protein, tumor necrosis factor-a measured values lower than the control group (P<0.01).Postoperative 24-hour,1L-6 concentration increased compared with the preoperative and postoperative 96 hours down to the preoperative level. Postoperative 24 hours in the experimental group, IL-6 concentrations measured values lower than the control group (P<0.01), postoperative 96 hours was no significant difference (P> 0.05).Postoperative albumin concentrations decreased, postoperative 24 hours to a minimum, postoperative 96 hours have increased, but still lower than the preoperative. Postoperative 24 hours in the experimental group, albumin concentrations measured values higher than the control group (P<0.05); postoperative 96 hours was significantly higher than the control group (P<0.01).Postoperative 24-hour D-lactate concentration increased compared with the preoperative. Postoperative 24 hours in the experimental group D-lactate concentration measured values lower than the control group (P<0.01).2. Changes in clinical observation in both groups:Compared with control group, objects in experimental group could be observed that postoperative hospital stay had been significantly reduced (P<0.01), time of postoperative passage of gas by anus had been advanced(P<0.01), weight loss had been significantly reduced(P<0.01) and treatment costs had been apparently decreased (P<0.01). The incidence of complications between the two groups had no statistically significant difference (P> 0.05) and no deaths had occurred in the two groups.Conclusion:Time shortening of the preoperative diet, intraoperative and postoperative transfusion control, postoperative pain relief, early postoperative feeding can effectively relieve the stress of patients after hepatobiliary surgery, and these acts do not increase the incidence of postoperative complications. They can accelerate postoperative recovery. They can also protect the intestinal barrer function and reduce the decrease of plasma albumin.