术前口服补液对腹腔镜结直肠癌根治术患者术后康复的影响  

Effect of preoperative oral rehydration on postoperative recovery in patients undergoing laparoscopic radical resection of colorectal cancer

作　　者：孟文君 魏昕 陈香香 疏树华 朱志强[1] 潘建辉 柴小青 Meng Wenjun, Wei Xin, Chen Xiangxiang, Shu Shuhua, Zhu Zhiqiang, Pan Jianhui, Chai Xiaoqing(Department of Anesthesiology, First Affiliated Hospital of University of Science and Technology of China Anhui Provincial Hospital, Hefei 230001, China)

机构地区：[1]中国科学技术大学附属第一医院安徽省立医院麻醉科,合肥市230001

出　　处：《中华麻醉学杂志》2018年第4期470-473,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金（81300970）

摘　　要：目的 评价术前口服补液对腹腔镜结直肠癌根治术患者术后康复的影响.方法 择期腹腔镜结直肠癌根治术患者80例,年龄18～64岁,BMI 18～ 24 kg/m^2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组（n=40）：常规补液组（R组）和术前口服补液组（O组）.R组患者术前8h禁食固体食物,6h禁水,术中按照经典诱导期容量填充及4-2-1方案进行补液.O组根据患者禁食时间,口服含糖电解质多维饮料,禁食8h时口服12～ 15 ml/kg,禁食8～12h时口服15～20 ml/kg,总量不超过1 200 ml,于术前3h口服300 ml,其余液体量于术前ld夜间分次饮完,术中按照基础需要量及术中液体丢失量行补液.2组术毕当日以1.5 ml·kg^-1 ·h^-1维持补液.记录患者口服补液量、术中液体净入量和术日静脉补液量;记录手术时间、苏醒时间、肛门排气时间、首次进食时间、下床时间和术后住院时间;记录患者术后恶心呕吐和低血压的发生情况.于入院2d、术日及术后1d（T0-2）晨（均为空腹时）抽取外周静脉血样4 ml,检测血糖浓度和胰岛素浓度,并计算胰岛素抵抗指数.结果 R组和O组分别纳入37和35例患者.与R组比较,O组患者术中液体净入量及术日静脉补液量降低,血糖、胰岛素浓度和胰岛素抵抗指数降低,肛门排气时间、首次进食时间及术后住院时间缩短（P＜0.05）.结论 术前口服补液可促进腹腔镜结直肠癌根治术患者术后康复,可能与减轻胰岛素抵抗有关.Objective To evaluate the effect of preoperative oral rehydration on postoperative recovery in patients undergoing laparoscopic radical resection of colorectal cancer.Methods Eighty patients of both sexes,aged 18-64 yr,with body mass index of 18-24 kg/m^2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical resection of colorectal cancer,were randomly divided into either routine fluid replacement group （group R） or oral rehydration group （group O） with 40 patients in each group.Fasting for solid food was performed at 8 h before surgery and for water at 6 h before surgery,and fluid was replaced according to the volume expansion during induction and 4-2-1 formula in group R.In group O,multivitamin drinks containing sugar and electrolyte was given orally according to the fasting time：12-15 ml/kg at 8 h of fasting,15-20 ml/kg at 8-12 h of fasting,with the total volume not exceeding 1 200 ml,300 ml at 3 h before surgery,and the rest of fluid was given at different times the night before surgery,and fluid replacement 1 200 ml was performed according to the basic requirement of patients and intraoperative fluid loss.Fluid replacement was maintained at a rate of 1.5 ml · kg^-1 · h^-1 on the day of surgery in two groups.The volume of oral fluid intake,intraoperative net volume of fluid intake and volume of intravenously given fluid on the day of surgery were recorded.The time of surgery,emergence time,time to first flatus,time to first liquid diet,first ambulation time and length of postoperative hospital stay were recorded.The development of postoperative nausea and vomiting and hypotension was recorded.Peripheral venous blood samples were collected on the morning of day 2 after admission to hospital,the day of surgery and day 1 after surgery （T0-2） for determination of the fasting blood glucose and insulin concentrations,and insulin resistance index was calculated.Results Thirty-seven and 35 patients were included in R and O groups,respectively.Compared with

关 键 词：补液疗法 康复 结直肠肿瘤 腹腔镜检查术 

分 类 号：R735.34[医药卫生—肿瘤]