术前碳水营养液在老年粗隆间骨折患者手术麻醉应用中的安全性研究

Study on the safety of carbohydrates-based nutritional liquid for pre-operation use in surgical anesthesia of elderly patients with intertrochanteric fracture

目的研究术前碳水营养液在老年粗隆间骨折患者手术麻醉中的安全性。方法前瞻性选取2022年4月至2023年5月江苏大学附属高淳医院收治的48例年粗隆间骨折患者作为研究对象。按随机数表法将其分为干预组(n=24)和对照组(n=24)。干预组患者在术前8 h禁食固体食物,术前2 h饮用200 mL的术前碳水营养液(碳水化合物含量12.5%的特殊医学用途碳水化合物组件配方食品),对照组患者术前8 h禁食、禁饮。记录两组患者的术前、术后主观状态、胃排空状态、麻醉术中指标(麻醉时间和血气状况)以及入院时和术中的空腹血糖、胰岛素、胰岛素抵抗指数水平。结果术前,干预组口渴患者比例为0,明显低于对照组(54.2%),差异有统计学意义(P<0.05);两组心悸、恐惧、饥饿、肌肉颤抖、头晕患者比例比较,差异均无统计学意义(P>0.05)。术后,两组患者均对于麻醉手术表示满意,未出现恶心、呕吐、头晕、谵妄患者。干预组患者麻醉前胃残余量为(0.23±0.08)mL,显著低于对照组[(0.38±0.11)mL],干预组患者血液的pH值、PaCO_(2)、HCO_(3)^(-)水平分别为7.38±0.04、(43.30±2.35)mmHg、(24.63±0.52)mmol/L,均高于对照组[7.34±0.03、(41.62±2.81)mmHg、(23.70±1.41)mmol/L],差异均有统计学意义(P<0.05)。干预组患者入院时的胰岛素抵抗指数为1.94(1.4,4.9),高于对照组[0.66(0.3,1.8)],入院时和术中的胰岛抵抗指数差值为1.19(0.1,3.4),高于对照组[-0.23(-0.6,1.0)],差异均有统计学意义(P<0.05);两组入院时和术中的血糖和血清胰岛素比较,差异均无统计学意义(P>0.05)。结论术前2 h饮用200 mL术前碳水营养液在老年骨科粗隆间骨折手术的麻醉中具有较高的安全性。

Objective To observe the safety of carbohydrates-based nutritional liquid for pre-operation use in surgical anesthesia of elderly patients with intertrochanteric fracture.Methods A total of 48 patients with intertrochanteric fractures admitted to Gaochun Hospital Affiliated to Jiangsu University from April 2022 to May 2023 were prospectively selected as the study subjects.They were divided into the intervention group(n=24)and the control group(n=24)according to random number table method.The patients in the intervention group were fasting from solid food for 8 hours before surgery,but drank 200 mL of carbohydrates-based nutritional liquid(special medical carbohydrate component formula with a carbohydrate content of 12.5%)for pre-operation use 2 hours before surgery;the patients in the control group were fasting and drinking-free for 8 hours before surgery.The subjective states before and after surgery,gastric emptying status,intraoperative anesthesia indicators(anesthesia time and blood gas status),the levels of fasting blood glucose,insulin,and insulin resistance index at admission and during surgery two groups were recorded.Results Before surgery,the proportion of thirsty patients in the intervention group was 0,which was significantly lower than that in the control group(54.2%),and the difference was statistically significant(P<0.05);there were no statistically significant differences in the proportion of patients with palpitations,fear,hunger,muscle tremors,and dizziness between the two groups(P>0.05).The residual volume of the intervention group before surgery was(0.23±0.08)mL,which was lower than that of the control group[(0.38±0.11)mL],the blood levels of pH,PaCO_(2),HCO_(3)^(-)were 7.38±0.04,(43.30±2.35)mmHg,and(24.63±0.52)mmol/L,respectively,which were higher than those in the control group[7.34±0.03,(41.62±2.81)mmHg,and(23.70±1.41)mmol/L],and the differences were statistically significant(P<0.05).The insulin resistance index of the intervention group patients at admission was 1.94(1.4,4.9),which was higher than that of the control group[0.66(0.3,1.8)],the difference in insulin resistance index between admission and surgery was 1.19(0.1,3.4),which was higher than that of the control group[-0.23(-0.6,1.0)],and the difference was statistically significant(P<0.05);there were no statistically significant differences in blood glucose and serum insulin between the two groups at admission and during surgery(P>0.05).Conclusion It is high safe during the anesthesia for the elderly patients with intertrochanteric fracture surgery to drink 200 mL of carbohydrates-based nutritional liquid for pre-operation use 2 hours during the before surgery.