假饲联合早期流质饮食对腹腔镜肝切除术后患者胃肠功能恢复的影响

The effect of sham feeding combined with early fluid diet on the recovery of gastrointestinal function after laparoscopic hepatectomy

目的探究假饲(咀嚼口香糖)联合早期流质饮食对腹腔镜肝切除术后患者胃肠功能的影响。方法选取2018年6月—2019年12月在金华市中心医院普外科接受腹腔镜肝切除手术的患者112例,按随机数字表法分为咀嚼组(36例)、对照组(38例)和空白组(38例)。咀嚼组:麻醉清醒后予以咀嚼口香糖(1次/2 h,每次2~3片,术后6 h流质饮食,3~5次/d);对照组:术后6 h予以流质饮食,3~5次/d;空白组:术后6 h进饮温开水,肛门排气后,给予流质食物。比较3组患者肠鸣音恢复、首次肛门排气、排便时间、血清胃动素、胃泌素水平及术后胃肠道症状。结果咀嚼组肠鸣音恢复、首次排气、排便时间[(9.76±1.59)h、(20.57±2.31)h、(56.82±8.27)h]均早于对照组[(11.08±1.96)h、(26.64±2.77)h、(64.33±10.39)h]及空白组[(15.26±2.09)h、(30.05±3.85)h、(72.94±11.67)h],差异均有统计学意义(t=3.171、10.207、3.428;12.688、12.756、6.822,均P<0.05);术后第1天咀嚼组患者胃动素和胃泌素水平均高于对照组和空白组(均P<0.05);咀嚼组患者术后恶心和呕吐发生率低于对照组和空白组(均P<0.05)。结论假饲联合早期流质饮食能够加快腹腔镜肝切除术患者胃肠功能的恢复。

Objective To explore the effect of sham feeding(chewing gum)combined with early liquid diet on the recovery of gastrointestinal function in patients with laparoscopic hepatectomy.Methods A total of 112 patients who underwent laparoscopic hepatectomy in the Department of General Surgery of Jinhua Central Hospital from June 2018 to December 2019 were selected as the study subjects.They were randomly divided into chewing group(36 cases),control group(38 cases)and blank group(38 cases).Chewing group:chewing gum(1 time/2 h,2~3 tablets each time)combined with early liquid diet(6 hours after operation,3~5 times/day).Control group:liquid diet was given 6 hours after operation,3~5 times/day.Blank group:drink warm boiled water 6 hours after operation,and give liquid food after anal exhaust.The recovery of bowel sounds,first anal exhaust,defecation time,serum motilin MTL,gastrin gas levels and postoperative gastrointestinal symptoms were compared among the three groups.Results The recovery of bowel sounds,first exhaust and defecation time in the chewing group[(9.76±1.59)h,(20.57±2.31)and(56.82±8.27)h]were significantly earlier than those in the control group[(11.08±1.96)h,(26.64±2.77)h,and(64.33±10.39)h],the blank group[(15.26±2.09)h,(30.05±3.85)h,and(72.94±11.67)h].The differences were statistically significant(t=3.171,10.207,3.428;12.688,12.756,6.822,all P<0.05).On the first day after operation,the levels of motilin MTL and gastrin gas in chewing group were higher than those in control group and blank group(all P<0.05).The incidence of postoperative nausea and vomiting in chewing group was lower than that in control group and blank group(all P<0.05).Conclusion Sham feeding combined with early liquid diet can effectively promote the recovery of gastrointestinal function after laparoscopic hepatectomy.