远隔缺血预处理对妇科肿瘤腹腔镜手术患者术后肠功能恢复的临床研究

Clinical application of remote ischemic preconditioning for postoperative intestinal function recovery in gynecological tumor patients undergoing laparoscopic surgery

摘要:

目的 评估远隔缺血预处理（RIPC）对妇科肿瘤腹腔镜手术患者术后肠功能恢复的效果。方法 该研究为单中心、双盲、前瞻性、随机对照试验。纳入2023年1月—2024年7月湖南省妇幼保健院60例接受腹腔镜手术的妇科肿瘤患者，随机分为RIPC组与对照组，每组30例。RIPC组通过上臂血压袖带进行3次充气-放气循环；对照组放置未充气袖带。比较两组二胺氧化酶（DAO）活性增幅、D-乳酸（D-LA）增幅、胃肠道功能评估系统（I-FEED）评分构成及肠功能恢复情况。结果 患者均完成研究，无失访。RIPC组的DAO活性增幅和D-LA增幅均低于对照组（P <0.05），I-FEED评分高分构成低于对照组（P <0.05）。RIPC组与对照组术后首次肛门排气时间比较，差异无统计学意义（P >0.05）。结论 RIPC作为一种简单、非侵入性干预手段，可减少妇科肿瘤手术中肠道损伤并促进术后肠功能恢复，具有临床应用潜力。

Abstract:

Objective To evaluate the effect of remote ischemic preconditioning (RIPC) on postoperative intestinal function recovery in gynecological tumor patients undergoing laparoscopic surgery.Methods In this single-center, double-blind, prospective, randomized controlled trial, 60 patients scheduled for gynecological laparoscopic surgery (January 2023-July 2024) were equally randomized to RIPC (n = 30) or control groups (n = 30). The RIPC group received three cycles of upper-limb cuff inflation-deflation; controls received a non-inflated cuff. Primary outcomes included postoperative changes in diamine oxidase (DAO) activity, D-lactate (D-LA) levels, Intestinal Function Evaluation (I-FEED) score distribution, and recovery indicators.Results All patients completed the study. The RIPC group demonstrated significantly lower postoperative increases in DAO activity and D-LA levels compared to controls (P < 0.05). Fewer patients in the RIPC group exhibited high I-FEED scores (P < 0.05). No significant difference was observed in time to first flatus between groups (P > 0.05).Conclusions RIPC effectively reduces intestinal injury biomarkers and improves functional recovery indicators in gynecological tumor patients undergoing laparoscopic surgery, supporting its clinical utility.