ERAS理念下术前口服碳水化合物对全身麻醉妇科腹腔镜手术患者的影响

Effect of ERAS concept on postoperative recovery of patients undergoing laparoscopic surgery

目的:探讨加速康复外科(ERAS)理念下口服碳水化合物对妇科腹腔镜手术患者血压及相关指标的影响。方法:采用电脑随机序列将100例患者随机分为2组,研究组(n=50)分别在术前10h和2~3h口服体积分数为12.5%的碳水化合物饮品800、400mL;对照组(n=50)术前常规禁食水8~12h。分别记录两组患者入室后(T0)、气管插管后即刻(T1)和气管插管后10min(T2)的收缩压(SBp)、舒张压(DBp)、心率(HR)。记录术中患者低血压需静脉注射甲氧明的例数及反流、误吸发生的例数。采用视觉模拟评分法(VAS)评估两组患者的口渴、饥饿程度。结果:两组患者的SBp、DBp和HR在T1和T2时较T0值均降低(P<0.05),对照组SBp、DBp、HR在T2时的值均显著低于研究组(P<0.05);研究组和对照组发生低血压给予甲氧明升压的例数分别为5例(10.0%)和18例(36.0%),差异有统计学意义(P<0.05);研究组入室后口渴和饥饿VAS评分均显著低于对照组(P<0.05);两组患者均未发生反流、误吸。结论:基于ERAS理念下口服碳水化合物可维持腹腔镜手术患者血压稳定,减少患者低血压、口渴及饥饿不适症状,且不增加术中反流、误吸的风险,值得推广应用。

Objective:To investigate the effects of accelerated rehabilitation surgery(ERAS)on blood pressure and related indexes in patients undergoing laparoscopic surgery under general anesthesia.Methods:A total of 100 patients were randomly divided into two groups by computer random sequence.The study group(n=50)was given 800 mL and 400ml of 12.5%carbohydrate drinks at the time of 10 h and 2-3 h before surgery,respectively.The control group(n=50)conducted the routine fasting for food and water 8-12 h before operation.SBp,DBp and HR of the two groups were recorded after entring the room(T0),the moment after endotracheal intubation(T1)and at 10 min after endotracheal intubation(T2).The number of patients with intraoperative hypotension requiring intravenous methoxamine injection and the incidence of reflux and aspiration were recorded.Thirst and hunger were evaluated by visual analogue scales.Results:.The values of SBP,DBP and HR of the two groups at T1 and T2 were lower than those in T0(P<0.05),and the values of SBP,DBP and HR at T2 in control group were significantly lower than those in study group(P<0.05).The number of cases of hypotension with methoxamine in the study group and the control group were5(10.0%)and 18(36.0%),respectively,and the difference was statistically significant(P<0.05).VAS scores of thirst and hunger in the study group were significantly lower than those in the control group(P<0.05).No regurgitation aspiration occurred in the two groups.Conclusion:Preoperative oral carbohydrate drinks for gyneoological general anesthesia patients undergoing laparoscopic surgery can maintain stable blood pressure,reduce the discomfortable symptoms of hypotension,thirst,hunger,and do not increase the risk of reflux aspiration during surgery.