术前口服碳水化合物在腹腔镜下全子宫切除术后快速康复中的应用及观察

The Aapplication of Preoperative Oral Carbohydrates in the Enhanced Recovery of Patients after Laparoscopic Hysterectomy

目的:评价术前口服碳水化合物(preoperative oral carbohydrate,POC)对妇科腹腔镜下全子宫切除手术患者围术期反流误吸、胃肠功能、及胰岛素抵抗(IR)的影响。方法:全麻下行腹腔镜全子宫切除术的患者60例,年龄41~64岁,ASA分级I-Ⅱ级,随机分为2组(n=30):隔夜禁食禁饮组术前禁食水8h-12h;碳水化合物组术前晚口服碳水化合物饮品800mL,麻醉前2 h口服碳水化合物饮品200mL。麻醉采用静吸复合气管内全麻。记录患者麻醉诱导、苏醒期反流误吸的发生情况、术后24h内恶心呕吐腹胀的情况、术后肛门排气时间、下床活动时间、住院天数、监测术前2h与术后1d、3d的空腹血糖(FPG)、空腹胰岛素水平(FINS),用稳态模式评估法计算稳态模型胰岛素抵抗指数(HOMA-IR)。结果:两组患者空腹血糖相比差异无统计学意义(P>0.05)。两组患者术后第一天、第三天血胰岛素水平均较术前升高,差异有统计学意义(P<0.05);碳水化合物组血胰岛素水平低于隔夜禁食禁饮组(P<0.05)。术后第一天、第三天FAST组HOMA-IR均较术前升高(P<0.05),POC组术后第一天HOMA-IR较术前升高(P<0.05);FAST组术前即有胰岛素抵抗出现,HOMA-IR高于POC组。结论:术前口服碳水化合物饮品不增加全麻患者围术期反流误吸风险,对加速患者腹腔镜术后的胃肠功能恢复有促进作用。

Objective:To evaluate the effect of preoperative oral carbohydrate(POC)on perioperative reflux,gastrointestinal function and insulin resistance(IR)in patients undergoing laparoscopic hysterectomy.Methods:60 patients(41-64 years old)under laparoscopic hysterectomy were randomly divided into two groups(n=30):overnight fasting group(FAST group),preoperative fasting for 8 h-12 h;preoperative oral carbohydrate group(POC group),carbohydrate drink 800 mL were given On the eve of the operation and carbohydrate drink 200 mL were given 2 h before surgery.Intratracheal general anesthesia were performed.The incidence of reflux and aspiration,nausea,vomiting and abdominal distention within 24 hours postoperation;time of anal exhaust,time of getting out of bed,length of stay were recorded.Fasting blood glucose(FPG)and fasting insulin level(FINS)were detected at 2 hours before operation,1 day postoperation and 3 days postoperation.Homa insulin-resistance(Homa IR)was calculated by homeostasis model assessment.Results:There was no significant difference in fasting plasma glucose between the two groups(P>0.05).The plasma insulin levels of the two groups were higher on the first day and the third day after operation than that before operation(P<0.05);the plasma insulin level of the POC group was lower than that of the FAST group(P<0.05).HOMA-IR of FAST group was higher than that of POC group(P<0.05)on the first day and the third day after operation(P<0.05).Conclusion:Preoperative carbohydrate drink does not increase the risk of reflux and aspiration in patients with general anesthesia,and it can enhanced the recovery of gastrointestinal function after laparoscopic surgery.