胃窦部超声指导下妇科腹腔镜手术患者术前口服10%葡萄糖溶液的临床应用

Clinical application of preoperative oral 10%glucose solution guided by antral ultrasonography in gynecological endoscopic surgery

目的研究在胃窦部超声指导下妇科腹腔镜手术患者术前2 h口服4 ml/kg、10%葡萄糖溶液的临床应用。方法选取2019年1月-2019年8月延安大学附属医院拟在全身麻醉下行腹腔镜手术的妇科患者60例作为研究对象,根据随机数字表法分为口服糖水组和常规禁饮组,每组30例。常规禁饮组术前常规禁食、禁饮8~12 h;口服糖水组常规禁食,术前2 h口服4 ml/kg、10%葡萄糖溶液。进入手术室后先用超声测量2种不同体位下的胃窦部横截面积(CSA):半卧位为CSA1,右侧卧位为CSA2。应用公式计算胃容量(GV)及单位体重胃容量(GV/W)。采用视觉模拟评分(VAS)分别在术前30 min与术前3 h对所有患者行口渴感、饥饿感及焦虑感评分,然后将不同时间的评分差值进行比较。记录两组术后首次排气及排便时间。结果两组CSA1、CSA2、GV1、GV2、GV1/W及GV2/W等胃超声测量数据比较,差异无统计学意义(P>0.05)。两组术前30 min与术前3 h口渴感、饥饿感及焦虑感的VAS评分差值比较,差异有统计学意义(P<0.05)。与常规禁饮组比较,口服糖水组术后首次排气时间缩短(P<0.05)。结论在胃窦部超声指导下妇科腹腔镜手术患者术前2 h口服4 ml/kg、10%葡萄糖溶液安全可行,并且可以改善患者术前的主观不适感,缩短术后首次排气时间,促进患者胃肠功能早期恢复。

Objective To study the application of oral 4 mL/kg and 10%glucose solution 2 hours before operation under the guidance of antral ultrasonography in gynecological laparoscopic surgery.Methods From January 2019 to August 2019,60 gynecological patients who were to undergo laparoscopic surgery under general anesthesia in our hospital were selected and divided into oral sugar water group and conventional drinking ban group with 30 cases for each according to the random number table method.Conventional drinking ban group received routine fasting and drinking for 8 to 12 hours before operation,while oral sugar water group received routine fasting and oral administration of 4 mL/kg and 10%glucose solution 2 hours before operation.After entering the room,the cross-sectional area of gastric antrum(cross-sectional area,CSA)under two different postures was measured by ultrasound.The semi-horizontal position was CSA1 and the right lateral position was CSA2.Then the gastric volume(gastric volume,GV)and unit weight gastric volume(GV/weight,GV/W)were calculated by the formula;VAS score method was used to score thirst,hunger and anxiety of all patients 3 hours and 30 min before operation respectively,and the difference between the two was further calculated;the postoperative first exhaust and defecation time of the two groups of patients were recorded.Results There was no significant difference in gastric antral cross-sectional area and predicted gastric volume between the oral sugar water group and the conventional drinking ban group(P>0.05).Compared with the conventional drinking ban group,the VAS scores of thirst,hunger and anxiety in the oral sugar water group 30 min before operation were lower than those in the preoperative 3 h(P<0.05).Compared with conventional drinking ban group,the first exhaust time in oral sugar water group was shortened(P<0.05).Conclusion It is safe and feasible for antral ultrasonography to guide gynecologic laparoscopic surgery patients to take oral 4 mL/kg and 10%glucose solution 2 hours before surgery,which can alleviate patients’subjective discomfort before surgery,shorten the first exhaust time after surgery and promote the early recovery of gastrointestinal function.