摘要
目的评价缩短创伤骨科择期手术患者围手术期禁食水时间的可行性。方法对2016年11月至2017年1月收治的190例创伤骨科择期手术患者进行前瞻性研究，将患者以病房为单位分为试验组（69例）和对照组（121例）。试验组术前6h禁食，术前2h口服麦芽糊精果糖饮品，之后禁饮；术后患者一旦清醒，即可进水，进水2h后恢复正常饮食。对照组术前1d夜间12点以后禁食水，术后臂丛神经阻滞麻醉患者不限制进水，其他患者术后6h后进水，无不适反应后恢复饮食。记录并比较两组患者术前禁饮、禁食时间及术后恢复进水、进食时间，比较两组患者术前、术后主观舒适度（焦虑、口渴、饥饿、恶心、疲劳、头晕、虚汗及胃部不适）及血糖，观察患者不良反应的发生情况。结果试验组患者术前禁饮时间[（4．5±2．9）h]较对照组[（14．3±3．9）h]缩短，术前禁食时间[（17．6±3．0）h]较对照组[（16．1±3．8）h]长，术后首次进水和进食时间[1（0，3）h和2（1，4）h]较对照组[（6（6，6）h和6（6，6）h]缩短，差异均有统计学意义（P〈0．05）。试验组患者围手术期焦虑、口渴、饥饿、恶心、疲劳、头晕和胃部不适情况优于对照组，差异均有统计学意义（P〈0．05）。两组患者人院时血糖比较差异无统计学意义（P〉0．05），术前试验组明显高于对照组（P〈0．05），但术后试验组血糖逐渐下降，两组比较差异无统计学意义（P〉0．05）。两组患者均无严重不良反应发生。结论缩短创伤骨科择期手术患者围手术期禁食水时间安全、可行，并且有助于减轻患者焦虑、口渴、饥饿、恶心、疲劳、头晕及胃部不适症状。
[Abstract] Objective To evaluate the effectiveness of perioperative fasting abbreviation in traumatic patients undergoing selective surgeries. Methods The traumatic patients undergoing selective surgeries from November 2016 to January 2017 at our department were selected for this prospective cohort study. They were divided into an intervention group （69 patients） and a control group （121 patients） according to the wards where they stayed. The intervention group was fasted for solids 6 hours prior to surgery and received oral solution with mahodextrin 2 hours prior to surgery. After surgery, they were allowed to drink liquids as soon as they were awakened. Normal food was allowed 2 hours later. The control group was fasted for either liquids or solids the night before surgery. After surgery, the patients who had received brachial plexus block only were allowed liquids with no limitation while the other patients were allowed liquids 6 hours after surgery and then were free for solids and liquids if no discomfort was observed. The time periods for preoperative liquids and solids fasting and for postoperative intake of liquids and solids were recorded and compared between the 2 groups. The perioperative well-beings （including anxiety, thirst, hunger, nausea, fatigue, dizziness, sweating and stomach discomfort） and serum glucose levels were compared between the 2 groups. Adverse reactions were observed. Results The preoperative fasting time for liquids for the intervention group （4.5 ±2.9 hours） was significantly shorter than that for the control group （14.3±3.9 hours） （ P 〈 0. 05） . The preoperative fasting time for solids for the intervention group （17.6 ± 3.0 hours） were significantly longer than that for the control group （16. 1 ±3.8 hours） （ P 〈 0. 05）. The postoperative fasting time periods for both liquids [ 1 （0, 3 ） h ] and solids [ 2 （1,4） hi for the intervention group were significantly shorter than those for the control group [6（6, 6） hi hours and [6（6, 6） hi （ P 〈 0. 05） . Compared with the control group, the perioperative anxiety, thirst, hunger, nausea, fatigue, dizziness and stomach discomfort were significantly improved in the intervention group （ P 〈 0. 05 ）. The average serum glucose level was similar in both groups upon admission （ P 〈 0. 05）; it was significantly higher in the intervention group immediately before surgery （ P 〈 0. 05 ） but was gradually decreased after surgery until there was no significant difference between the 2 groups （ P 〉 0. 05 ）. No major adverse reaction was observed in either group. Conclusion The protocol of perioperative fasting abbreviation may be safe and feasible in traumatic patients for selective surgeries, showing benefits of decreased anxiety, thirst, hunger, nausea, fatigue, dizziness and stomach discomfort.
作者
李庭
周雁
孙旭
孙志坚
姜矞恒
鲁雪梅
彭贵凌
张春玲
姜耀
孙胜男
伊辰
安岩
王含
韩冰
王庚
吴新宝
Li Ting;Zhou Yan;Sun Xu;Sun Zhijian;Jiang Yuheng;Lu Xue- mei;Peng Gulling;Zhang Chunling;Jiang Yao;Sun Shengnan;Yi Chen;An Yan;Wang Han;Han Bing;Wang Geng;Wu Xinbao(Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2018年第4期312-317,共6页
Chinese Journal of Orthopaedic Trauma
关键词
围手术期医护
创伤和损伤
禁水
禁食
Perioperative care
Wounds and injuries
Water deprivation
Fasting
