术前口服碳水化合物对ERCP患者围手术期的影响研究

Effect of preoperative oral carbohydrate intake in patients undergoing ERCP

目的评价术前口服碳水化合物对经内镜逆行性胰胆管造影术(ERCP)手术患者的安全性及有效性。方法回顾性分析2019年3月至2019年8月接受ERCP手术治疗的各类胆道疾病患者的临床资料。根据围术期饮食管理理念的不同分为对照组(n=63)和ERAS组(n=69)。对照组术前禁食、禁水6 h;ERAS组术前2 h给予麦芽糊精果糖饮品400 ml。运用SPSS 21.0软件进行数据分析,术后疲劳程度评分、腹痛评分、术后18 h血清学指标以(±s)表示,采用独立t检验;术后并发症比较采用χ2检验,Fisher确切概率法进行校正,P<0.05为差异有统计学意义。结果ERAS组患者的术后疲劳程度评分(2.4±1.6)、术后18 h血糖(5.3±1.5)mmol/L、术后住院时间(26.6±5.0)h及住院费用(2.1±0.2)万元均低于对照组,差异均有统计学意义(P<0.05);两组患者术后腹痛评分、术后并发症发生率、术后18 h血清淀粉酶及白细胞水平等,差异无统计学意义(P>0.05)。结论术前口服碳水化合物有利于缓解ERCP患者的围术期疲劳及饥饿感,降低患者胰岛素抵抗,加速术后康复,缩短住院时间,减少住院费用。相较于传统围手术期管理理念,更为安全有效。

Objective To analyze the safety and effectiveness of preoperative oral carbohydrates intake for patients undergoing endoscopic retrograde cholangiopancreatography(ERCP).Methods The clinical data of patients with various biliary diseases who received ERCP from March 2019 to August 2019 were retrospectively analyzed.They were divided into control group(n=63)and ERAS group(n=69)according to the different perioperative diet management concepts.The fasting time was 6 hours in the control group and 2 hours in the ERAS group respectively.400 ml of oral carbohydrate was given in the ERAS group 2 hours before ERCP.SPSS21.0 software was used to analyze the data.The scores of postoperative fatigue,the scores of abdominal pain,the serological indicators at 18h after ERCP were expressed as mean±standard deviation and were examined by independent t test.The post-operative complications were examined by chisquare test,and Fisher exact probability method was used for correction.A P value of<0.05 was considered as statistically significant.Results The scores of postoperative fatigue(2.4±1.6),the serum glucose at 18h after ERCP(5.3±1.5 mmol/L),the length(26.6±5.0 h)and the cost of stay(20897.9±2108.5 yuan)were lower in the ERAS group than those in the control group(P<0.05).There was no significant difference between two groups in the scores of abdominal pain,complication rate,serum amylase and leukocyte at 18h after ERCP(P>0.05).Conclusion Preoperative oral carbohydrates intake is safe for patients undergoing ERCP,which is beneficial to relieve perioperative fatigue and hunger,reduce insulin resistance,accelerate postoperative rehabilitation,shorten the length of stay and reduce the cost of hospitalization.