口服碳水化合物对结直肠癌手术患者的影响

Effect of oral carbohydrate loading on the prognosis of patients undergoing colorectal surgery

目的探索术前及术后早期口服碳水化合物对结直肠癌手术患者预后的影响。方法选择2019年3月—7月于重庆医科大学附属第一医院择期行腹腔镜结直肠癌手术患者共184例,采用随机数字表法将其分为饮水组(n=93)和禁饮组(n=91)。饮水组术前2 h喝5 mL/kg碳水化合物清饮料,术后4 h开始口服碳水化合物。禁饮组术前禁饮8 h,术后排气后开始进饮。观察两组患者胃肠道恢复排气排便时间、并发症发生率(包括误吸、术后肠梗阻、吻合口瘘、切口感染、术后恶心呕吐、肺部感染)、术后住院时间及总住院费用。结果与禁饮组相比,饮水组患者术后恢复排气(Z=-8.009,P<0.001)、排便时间提前(Z=-6.263,P<0.001),术后总并发症发生率降低(χ^2=12.603,P<0.001),术后住院时间缩短(t=-5.891,P<0.001)。总住院费用两组之间差异无统计学意义(t=-1.860,P=0.065)。结论结直肠癌手术患者术前及术后早期口服碳水化合物安全可行,可明显降低总体并发症发生率,缩短术后住院时间,促进患者快速康复。

Objectives To explore the effect of preoperative and early postoperative oral carbohydrate on the prognosis of patients undergoing colorectal cancer surgery.Methods A total of 184 patients who underwent laparoscopic colorectal cancer surgery at the First Affiliated Hospital of Chongqing Medical University from March 2019 to July 2019 were selected.They were randomly divided into two groups:the drinking group(n=93)and the non-drinking group(n=91)using a random number table method.The drinking group drank 5 mL/kg carbohydrate clear drink 2 hours before surgery and began to take carbohydrate orally 4 hours after surgery.The non-drinking group was not allowed to drink for 8 hours before surgery and began to drink after exhaustion.The time to first flatus,first defecation in the two groups were observed.The incidence of complications(including aspiration,postoperative intestinal obstruction,anastomotic leakage,incision infection,postoperative nausea and vomiting,and pulmonary infection),postoperative length of stay and total cost of stay in the two groups were observed.Results Compared with the non-drinking group,the time to first flatus(Z=-8.009,P<0.001),the time to first defecation in the drinking group was significantly shorter(Z=-6.263,P<0.001),the incidence of postoperative complications was significantly lower(χ^2=12.603,P<0.001),the length of postoperative hospitalization was shorter(t=-5.891,P<0.001).There was no statistical difference in total hospital expenses between the two groups(t=-1.860,P=0.065).Conclusions Oral administration of carbohydrate before and early after colorectal cancer surgery is safe and feasible,which can significantly reduce the overall complications,shorten the length of postoperative hospital stay,and promote the rapid recovery of patients.