术前口服复方碳水化合物饮品对妇科腹腔镜手术后胃肠功能的影响

Effect of preoperative oral complex carbohydrate drinks on postoperative gastrointestinal function in patients undergoing gynecological laparoscopic surgery

目的评价术前口服碳水化合物饮品对妇科腹腔手术后胃肠功能的影响.方法择期全麻下行腹腔镜子宫手术患者90例,年龄18~64岁,体重指数18~25 kg/m^2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为3组(n=30):术前常规禁食禁饮组(C组)、术前静脉输注葡萄糖组(Ⅴ组)和术前口服复方碳水化合物饮品组(O组).Ⅴ组术前3h静脉输注5%葡萄糖溶液8 ml/kg,经30 min输完;O组术前3h口服复方碳水化合物饮品355 ml,经30 min口服完毕.记录反流误吸发生情况、肠鸣音恢复时间、肛门排气/排便时间,术后48 h内恶心、呕吐、腹胀的发生情况.于术前6h和术后6h时采用放射免疫分析方法检测血浆胃动素水平和血清胃泌素水平.麻醉诱导前采用超声测量胃窦面积.于术前1h、术后4和24 h时行焦虑自评量表(SAS)评估围术期焦虑状况.结果患者均未见反流误吸发生.与C组比较,O组肠鸣音恢复时间、肛门排气/排便时间缩短,恶心、呕吐和腹胀发生率降低,术后6h时血浆胃动素水平和血清胃泌素水平升高,术后4和24 h时SAS评分降低,Ⅴ组术前1h时SAS评分降低(P<0.05),其余指标差异无统计学意义(P>0.05);与Ⅴ组比较,O组肠鸣音恢复时间、肛门排气/排便时间缩短,恶心、呕吐和腹胀发生率降低,术后6h时血浆胃动素水平和血清胃泌素水平升高,术前1h、术后4和24 h时SAS评分降低(P<0.05).结论术前3h口服复方碳水化合物饮品355 ml可促进妇科腹腔镜手术后胃肠功能恢复,不增加围术期反流误吸风险.

Objective To evaluate the effect of oral compound carbohydrate drinks before operation on the postoperative recovery of gastrointestinal function in the patients undergoing gynecological laparoscopic operation.Methods Ninety American Society of Anesthesiologists physical statusⅠorⅡpatients,aged 18-64 yr,with body mass index of 18-25 kg/m^2,scheduled for elective gynecological laparoscopic operation under general anesthesia,were divided into 3 groups(n=30 each)using a random number table method:routine fasting and water deprivation group(group C),preoperative intravenous infusion of glucose group(group V),and oral compound carbohydrate drinks group(group O).In group V,5% glucose solution 8 ml/kg was intravenously injected over 30 min starting from 3 h before operation.In group O,compound carbohydrate drinks 355 ml was given orally within 30 min starting from 3 h before operation.The occurrence of reflux or aspiration,recovery time of bowel sounds and time of passing flatus/defecating time were recorded.The occurrence of nausea,vomiting and bloating was recorded within 48 h after operation.The levels of plasma motilin(MTL)and serum gastrin(GAS)were determined using radioimmunoassay at 6 h before and after operation.The area of gastric antrum was measured before anesthesia induction.Anxiety was assessed using Self-rating Anxiety Scale(SAS)at 1 h before operation and 4 and 24 h after operation.Results No patients developed reflux or aspiration.Compared with group C,the recovery time of bowel sounds and time of passing flatus/defecating time were significantly shortened,the incidence of nausea,vomiting and bloating was decreased,the levels of plasma MTL and serum GAS were increased at 6 h after operation,and SAS scores were decreased at 4 and 24 h after operation in group O,and SAS scores were significantly decreased at 1 h before operation(P<0.05),and no significant changes were observed in the other indexes in group V(P>0.05).Compared with group V,the recovery time of bowel sounds and time of passing flatus/defecating time were significantly shortened,the incidence of nausea,vomiting and bloating was decreased,the levels of plasma MTL and serum GAS were increased at 6 h after operation,and SAS scores were decreased at 1 h before operation and 4 and 24 h after operation in group O(P<0.05).Conclusion Oral compound carbohydrate drinks 355 ml at 3 h before operation can promote the postoperative recovery of gastrointestinal function without increasing the risk of reflux or aspiration in the patients undergoing gynecological laparoscopic operation.