机构地区:[1]北京积水潭医院麻醉科,100035 [2]北京积水潭医院创伤骨科,100035 [3]北京积水潭医院护理部,100035 [4]云南省曲靖市第二人民医院骨科,655000
出 处:《中华创伤骨科杂志》2018年第10期874-882,共9页Chinese Journal of Orthopaedic Trauma
摘 要:目的评估骨折手术患者术前口服碳水化合物饮料进行糖预处理的安全性,以及对患者围术期状态的影响。方法采用前瞻性对照研究的方法以2016年8月至2017年8月北京积水潭医院创伤骨科骨折择期手术患者为研究对象,以楼层为分组标准分为2组:传统禁食水组(TF组),术前按原有处理流程术前ld晚上12点钟后禁食禁饮;糖预处理组(PCT组),术前1d及手术当天进行糖预处理饮用12.6%的麦芽糊精果糖饮品。两组患者均按加速康复外科要求进行围术期管理。测量和比较两组患者入院时、术前即刻、术后即刻、术后1d晨起空腹血糖值,比较两组患者主观感受、握力及不良反应发生情况,以及患者对围术期禁食水管理流程的满意程度。结果共171例患者完成观察研究,TF组112例,PCT组59例。PTC组患者术前即刻血糖值[(5.9±1.0)mmol/L]高于TF组患者[(5.2±0.6)mm01/L],TF组患者术前即刻、术后即刻、术后1d血糖值[(5.2±0.6)mmol/L、(5.4±1.1)mmoI/L、(5.4±1.0)mm01/L1低于入院时[(5.7±1.1)mmol/L],PTC组患者术后即刻和术后1d血糖值[(5.4±0.7)mmol/L和(5.2±0.7)mmol/L]低于人院时和术前即刻[(5.9±1.0)mmol/L和(5.9±1.0)mmol/L],差异均有统计学意义(P〈0.05)。与TF组患者比较,PTC组患者主观感受的不适程度较轻。PTC组患者术后即刻和术后1d握力值[(34.3±10.4)kg]和[(34.5±10.9)kg]高于TF组患者[(29.14-13.1)kg]和(30.1±12.0)kg],PET组患者较TF组患者对围术期禁食水管理满意度高[9(9,9)m8(7,9)],差异均有统计学意义(P〈0.05)。结论骨折择期手术患者术前口服碳水化合物饮料进行糖预处理安全可行,并可改变患者空腹情况下的能量储存,改善了患者围术期主观感受。Objective To evaluate the safety of preoperative oral carbohydrate treatment for the patients in Enhanced Recovery After Surgery (ERAS) and the treatment effect on the perioperative state of the patients. Methods A prospective controlled research was conducted in the patients who had received selective operation for fractures at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from August 2016 to August 2017. They were divided into 2 groups according to the floor where they stayed. In the tra-ditional fasting group (group TF), fasting was performed one day before operation at 12:00 p. m. ; in the pre-operative carbohydrate treatment group (group PCT), 12.6% mahodextrin fructose beverage was indicated one day before operation and on the day of operation. The patients in both groups were managed according to ERAS requirements perioperatively. The fasting blood glucose values were measured at admission, just before oper-ation, immediately after operation, and on the next day after operation. The subjective feelings, grip strength and adverse reactions in the 2 groups were observed and recorded. Results A total of 171 patients, 112 in group TF and 59 in group PCT, participated in the whole observation. The blood glucose value just before operation in group PTC(5.9 ± 1.0 mmol/L) was significantly higher than that (5.2 ± 0. 6 retool/L) in group TF ( P 〈 0. 05). In group TF, the blood glucose values immediately before operation, immediately and on the next day after operation (5.2 ±0.6 mmol/L, 5.4 ± 1.1 mmol/L and 5.4 ± 1.0 mmol/L) were significantly lower than that at admission (5.7 ± 1.1 mmol/L) ( P 〈 0. 05); in group PTC, the blood glucose values immediately and on the next day after operation (5.4 ± 0.7 mmol/L and 5.2 ± 0. 7 mmol/L) were significantly lower than those immediately before operation and at admission (5.9 ± 1.0 mmol/L and 5.9 ± 1.0 mmol/L) ( P 〈 0. 05) . Patients in group PTC reported milder uneasy subjective feelings than tho
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