术前口服碳水化合物对胆囊手术患者胃排空效果的观察

Effect of oral carbohydrates before gallbladder surgery on gastric emptying

目的通过术前口服一种碳水化合物电解质保健品(乐棠)观察全麻胆囊手术患者的胃排空效果,评估该术前补液方案的安全性和有效性。方法选择南京医科大学附属江宁医院普外科全麻下行腹腔镜胆囊切除术患者372例,男女不限,年龄18~65周岁,ASA分级Ⅰ、Ⅱ级。采用随机数字表法将最终筛选入组的100例患者分为两组(每组50例):经口补充乐棠组(试验组)和术前自行口服清饮料或白开水组(对照组)。试验组在手术前夜口服800 ml乐棠,手术当天术前2 h口服400 ml乐棠,对照组术前禁食6 h、禁饮2 h,患者禁饮前可自行饮用清饮料或白开水,总量不超过400 ml,两组患者均在术前2.0 h(T_(0))、1.5 h(T_(1))、1.0 h(T_(2))、0.5 h(T_(3))行超声胃窦部扫查,记录胃窦部横截面积(cross-sectional area,CSA)和胃容积(gastric volume,GV)。两组患者麻醉诱导和术中麻醉维持方案相同。记录两组患者麻醉前、术后入PACU监测的电解质,术后3 d内恶心、呕吐、低血糖发生率及不良反应总发生率。结果试验组T_(1)时胃窦部CSA和GV高于对照组(P<0.05),两组患者其余时点胃窦部CSA和GV差异无统计学意义(P>0.05)。试验组麻醉前K+水平高于对照组(P<0.05),术后3 d内低血糖发生率及不良反应总发生率低于对照组(P<0.05),两组患者其余时点电解质结果及不良反应发生率比较差异无统计学意义(P>0.05)。结论全麻下行胆囊切除术的患者,采用手术前晚口服800 ml、手术当天术前2 h口服400 ml乐棠的补液方案,术前胃排空情况良好,且对围手术期血清钾和术后低血糖有改善作用。

Objective To observe the effect of pre-operative oral administration of a carbohydrate electrolyte supplement(Letang)on gastric emptying in patients undergoing gallbladder surgery under general anesthesia and evaluate its safety and effectiveness.Methods A total of 372 patients,men or women,aged 18-65 years,the American Society of Anesthesiologists(ASA)physical statusⅠorⅡ,who were admitted to Department of General Surgery,the Affiliated Jiangning Hospital of Nanjing Medical University and underwent laparoscopic cholecystectomy under general anesthesia were selected and finally 100 patients were enrolled.According to the random number table method,they were divided into two groups(n=50):an oral supplementation of Letang group(experimental group)and a preoperative self-administered oral clear fluids or boiled water group(control group).Patients in the experimental group orally took 800 ml Letang at the night before surgery and took 400 ml Letang at pre-operative 2 h.The control group underwent 6-hour-long fasting for foods and 2-hour-long fasting for water,where patients were allowed to drink clear drinks or boiled water by themselves before fasting for water,and the total amount was not more than 400 ml.Both groups underwent ultrasound examination of the gastric antrum at pre-operative 2.0 h(T_(0)),1.5 h(T_(1)),1.0 h(T_(2)),and 0.5 h(T_(3))and their antral cross-sectional area(CSA)and gastric volume(GV)were recorded.The same procedures were performed for anesthesia induction and intraoperative anesthesia maintenance in the two groups.Their electrolyte results before anesthesia and after entry into post-anesthesia care unit(PACU)were monitored,while the incidences of nausea,vomiting and hypoglycemia within three days after surgery were recorded.Results The experimental group showed higher CSA and GV than the control group at T_(1)(P<0.05).There was no statistical difference in CSA and GV between the two groups at other time points(P>0.05).The level of potassium ion in the experimental group before anesthesia was higher than that in the control group(P<0.05),and the incidence of hypoglycemia and adverse reactions within three days after surgery were lower than those in the control group(P<0.05).There were no statistical difference in electrolyte results and adverse reaction between the two group at other time points(P>0.05).Conclusions For patients undergoing cholecystectomy under general anesthesia,it is necessary to orally take 800 ml Letang at the night before surgery and 400 ml Letang at pre-operative 2 h,which leads to good gastric emptying before surgery and improvement in perioperative serum potassium and postoperative hypoglycemia.