缩短围手术期禁食时间对甲状腺手术快速康复的影响

Effect of shortening perioperative fasting time on rapid recovery of thyroid surgery

目的探讨缩短术前禁食时间对甲状腺手术快速康复的影响。方法选择2016年6—12月在四川大学华西医院行甲状腺癌手术的患者120例,按照其手术时间的先后顺序分为观察组和对照组各60例。对照组术前禁食12 h,禁饮6 h,术后6 h后进饮不发生呛咳则进食。观察组患者应用FTS理念,术前禁食6 h,禁饮4 h,术后4 h后进饮不发生呛咳则进食。检测2组患者术前1 d、术中与术后1 d外周血皮质醇与血糖水平,观察比较应激反应情况。结果2组患者发生术中呕吐/误吸[0(0.00%)vs.0(0.00%)]及术后恶心[7(11.67%)vs.5(8.33%)]、呕吐[3(5.00%)vs.4(6.67%)]情况比较,差异无统计学意义(χ^2=0.370、0.152,均P>0.05);观察组患者术前、术后口渴/饥饿感发生率[3(5.00%)、2(3.33%)]低于对照组[55(91.67%)、58(96.67%)],术后住院时间[(5.1±1.3)d]少于对照组[(6.3±1.1)d],差异有统计学意义(χ^2=90.234、104.530,t=5.165,均P<0.05)。术中观察组外周血皮质醇[(493.6±116.7)ng/L]显著低于对照组[(548.1±116.4)ng/L],差异有统计学意义(t=2.327,P<0.05);术后1 d,观察组外周血皮质醇水平[(500.2±121.3)ng/L]显著低于对照组[(592.4±119.2)ng/L],差异有统计学意义(t=2.906,P<0.05)。术后1 d,观察组空腹血糖[(5.5±0.8)mmol/L]显著低于对照组[(7.3±1.0)mmol/L],差异有统计学意义(t=10.887,P<0.05)。结论缩短甲状腺癌围术期禁食禁饮时间可以减少患者围术期不适感,促进患者早期康复,缩短住院时间,同时还为甲状腺手术快速康复的专家共识撰写提供循证依据,进一步加快了快速康复在甲状腺疾病中的运用进程。

Objective To explore the effect of shortening preoperative fasting time on rapid recovery of thyroid surgery.Methods A total of 120 cases of patients who underwent thyroid cancer surgery in our hospital from June to December 2016 were selected and divided into observation group and control group according to the operating time sequence,60 ca-ses in each group.In the control group,patients were undergoing routine fasting 12 h and forbidden to drink 10 h before surgery,they were allowed to eat if backward choking did happen when they drank 6 h after surgery.In the observation group,according to the theory of fast-track surgery,patients were forbidden to eat 6 h and to drink 4 h before surgery,they were allowed to eat if backward choking did happen when they drank 4 h after surgery.The levels of cortisol and blood sugar in peripheral blood of the two groups were measured one day before operation,during operation and one day after operation.The stress reaction during the observation period was analyzed by χ^2 test,t test and F test.Results There was no significant difference in intraoperative vomiting/aspiration[0(0.00%)vs.0(0.00%)],postoperative nausea[7(11.67%)vs.5(8.33%)]and vomiting[3(5.00%)vs.4(6.67%)]between the two groups(χ^2=0.370,0.152,all P>0.05).The incidence of thirst and hunger in the observation group[3(5.00%),2(3.33%)]was lower than those in the control group[55(91.67%),58(96.67%)]before and after operation,and postoperative hospital stay[(5.1±1.3)d]was less than that of the control group[(6.3±1.1)d],with the statistically significant difference(χ^2=90.234,104.530,t=5.165,all P<0.05).The intraoperative cortisol levels in the observation group[(493.6±116.7)ng/L]was significantly lower than that in the control group[(548.1±116.4)ng/L,t=2.327,P<0.05].The level of cortisol in peripheral blood of the observation group[(500.2±121.3)ng/L]was significantly lower than that of the control group[(592.4±119.2)ng/L]one day after operation(t=2.906,P<0.05).One day after operation,the fasting blood glucose in the observation group[(5.5±0.8 mmol/L]was significantly lower than that in the control group[(7.3±1.0)mmol/L,t=10.887,P<0.05].Conclusion It is safe and feasible to shorten the fasting time during thyroid cancer surgery in the theory of fast-track surgery,which not only can reduce the discomfort of patients and promote the early recovery of the patients,but also shorten the length of hospital stay.At the same time,it provides evidence for experts of thyroid and further the process of the use of FTS in thyroid disease.