Effect of enhanced recovery after surgery on immune function in patients with acute abdomen

Abstract

Objective To evaluate the effect of enhanced recovery after surgery (ERAS) on immune function and clinical signs in patients with acute abdomen. Methods From March 2016 to March 2017, patients with acute abdominal admitted in the Emergency Care Center of the First Affiliated Hospital of Zhengzhou University were collected and randomized into ERAS group and conventional peri-operative management group(CPM group). In addition to clinical signs (the time of bowel movemtn recovery, the time of first postoperative ingestion and ambulation, hospital stay, complication rates), the celluar immunity (CD4+ , CD8+ , CD4+ /CD8+ ) were determined during peri-operation period. Results A cohort of 240 patients were in ERAS group and 192 patients in CPM group. There was no significant difference in general condition between the two groups (P> 0.05). On the first day after operation, the levels of CD4+ , CD4+ /CD8+ decreased in both groups (P<0.05), but the CPM group had lower levels of CD4+ , CD4+ /CD8+ than the ERAS groups. On the 3rd and 7th days after surgery, the ERAS groups had higer levels of CD4+ , CD4+ /CD8+ than the CPM groups, (the levels of CD4+ , CD4+ /CD8+ recovery on the 3rd and 7th day after operation, and the ERAS group was significantly better than the CPM group) (P<0.05). Compared with CPM group, the recovery of bowel movement appeared earlier after operation in ERAS group with sooner resuming ingestion and ambulation after operation, shorter hospital stay, and lower WHO pain rating scale and complication rates(P<0.05). Conclusions ERAS for patients with acute abdomen can alleviate postoperative suppression of immunity, preserving immune function intact and accelerating postoperative rehabilitation. Key words: Enhanced recovery after surgery; Acute abdomen; Operation; Cellular immunity