基于ERAS理念的围手术期营养干预对老年胆囊结石患者应激反应与免疫功能的影响OA

[Objective]To investigate the effects of perioperative nutritional intervention based on the Enhanced Recovery After Surgery(ERAS)concept on surgical stress response and immune function in elderly patients with cholecystolithiasis.[Method]A prospective randomized controlled trial was conducted.A total of 160 elderly patients(aged≥60 years)with cholecystolithiasis admitted to the Department of Surgery,Taihe County Hospital of Traditional Chinese Medicine,the Seventh Affiliated Hospital of Anhui University of Chinese Medicine,from September 2022 to December 2025 were enrolled and randomly assigned to an intervention group(n=80)or a control group(n=80).The control group received routine perioperative nutritional manage-ment,while the intervention group received a perioperative nutritional intervention protocol based on the ERAS concept in addition to routine care.The protocol included preoperative nutritional screening and assessment,oral carbohydrate loading(400 mL of 12.5％maltodextrin beverage)2 hours before surgery,and resumption of oral intake and oral nutritional supplementation(providing 600 kcal/day,containing 25 g protein)2 hours after surgery.Serum stress response markers(cortisol,epinephrine,C-reactive protein,and fasting blood glucose),immune function parameters(percentages of CD3⁺,CD4⁺,and CD8⁺ T-lymphocyte subsets,CD4⁺/CD8⁺ ratio,and immunoglobulin IgA,IgG,and IgM levels),and nutritional indicators(serum albumin,prealbumin,and transferrin)were compared between the two groups preoperatively,and at 24 h and 72 h postoperatively.Postoperative recovery parameters and the incidence of infectious complications were also recorded.[Result]No statistically significant differences in baseline characteristics were observed between the two groups(P>0.05).At 24 h postoperatively,serum levels of cortisol,epinephrine,C-reactive protein,and fasting blood glucose in the intervention group were significantly lower than those in the control group(all P<0.05).At 72 h postoperatively,the percentages of CD3⁺ and CD4⁺ T cells and the CD4⁺/CD8⁺ ratio in the intervention group were significantly higher than those in the control group(all P<0.05),while the percentage of CD8⁺ T cells was significantly lower(P<0.05).Serum IgA,IgG,and IgM levels in the intervention group were also significantly higher than those in the control group at 72 h postoperatively(all P<0.05).At 72 h postoperatively,serum albumin,prealbumin,and transferrin levels in the intervention group were significantly higher than those in the control group(all P<0.05).The time to first flatus,time to first oral intake,and total length of hospital stay in the intervention group were significantly shorter than those in the control group(all P<0.05),and the incidence of postoperative infec-tious complications was significantly lower in the intervention group(P=0.018).[Conclusion]Perioperative nutritional intervention based on the ERAS concept can effectively alleviate postoperative stress response,improve immune function,accelerate postoperative recovery,and reduce the incidence of infectious complica-tions in elderly patients with cholecystolithiasis,demonstrating good clinical application value.