术前口服术能对腹腔镜全子宫切除手术患者安全性及舒适性的影响

Effect of preoperative oral outfast on safety and comfort of patients undergoing laparoscopic hysterectomy

目的:研究腹腔镜全子宫切除术患者术前口服术能对患者安全性及舒适性的影响。方法:选取2018年1月至12月在广东医科大学附属医院妇科择期行腹腔镜全子宫切除术的90例患者,随机分为A、B、C三组,每组30例。患者均于手术前8 h禁食,A组患者在术前3 h口服200 mL术能,B组患者在术前3 h口服200 mL温开水,C组患者术前3 h不服用任何液体,三组均行腹腔镜全子宫切除术,用视觉模拟评分法(VAS)测定三组患者的主观舒适度包括术后口渴感、饥饿感及焦虑感,术后恶心呕吐的发生率,根据患者外周血葡萄糖和胰岛素浓度,用稳态模式评估法(Homeostasis model assessment,HOMA)计算胰岛素抵抗指数(Insulin resistant index,IRI),记录肛门首次排气时间及术后住院时间。结果:三组术前进行气管插管时均未发生呕吐、误吸等并发症;A、B组术前口渴、饥饿发生率差异无统计学意义(P>0.05),但均低于C组(P<0.05);A组术后恶心呕吐的发生率低于B、C两组(P<0.05);三组患者术后肛门首次排气时间及术后住院时间比较,差异无统计学意义(P>0.05);术毕A组的IRI低于B、C两组(P<0.05)。结论:术前3 h口服200 mL术能是安全可行的,不仅降低术后胰岛素抵抗,还能提高患者主观舒适度,有利于腹腔镜全子宫切除术患者的康复。

Objective:To study the significance of preoperative oral outfast on the safety and comfort of patients undergo⁃ing laparoscopic hysterectomy.Methods:A total of 90 cases of gynecological laparoscopic surgery were randomly divid⁃ed into three groups:A,B and C,30 cases in each group.All the patients fasted 8 hours before the operation,Group A took 200 mL of oral outfast 3 hours before the operation,Group B took 200 mL of warm boiled water 3 hours before the op⁃eration,Group C did not take any liquid 3 hours before the operation.The three groups all underwent laparoscopic opera⁃tion,and the subjective comfort of the three groups was measured by VAS.Then the incidence of thirst,hunger,nausea and vomiting were compared among the three groups.According to the concentration of glucose and insulin in patients'peripheral blood,the insulin resistance(IR)index was calculated by homeostasis mode assessment(HOMA).The first postoperative anal exhaust time,postoperative hospital stay,and postoperative complications were recorded.Results:There were no complications of vomiting and inhalation during tracheal intubation in three groups.The scores of thirst and hunger before operation was not statistically significant(P>0.05),but they were much lower than that of Group C(P<0.05).The incidence of nausea and vomiting after operation in Group A was much lower than that of the other two groups(P<0.05).There was no significant difference in the first exhaust time among the three groups(P>0.05).After operation,the IR in Group A was much lower than that of the other two groups(P<0.05).Conclusion:Taking 200 mL of oral outfast 3 hours before surgery can increase the patient's subjective comfort by reducing the preoperative discomfort(thirst and hunger)and reduce the incidence of postoperative nausea and vomiting in patients undergoing elective gyneco⁃logic laparoscopic surgery,it is effective on postoperative insulin resistance,and has a positive effect on postoperative rapid recovery.