术前口服碳水化合物对胆囊结石微创手术围术期应激反应及术后胃肠功能恢复的影响  

Effect of oral carbohydrate before operation on perioperative stress response and postoperative gastrointestinal function recovery in minimally invasive cholecystolithiasis

作　　者：朱惠刚 左艳菊 刘东升 陈清亮 ZHU Huigang;ZUO Yanju;LIU Dongsheng;CHEN Qingliang(Department of Hepatobiliary Surgery,The Third people's Hospital of Henan Province,Zhengzhou,Henan 450006,China;Digestive Disease Center,The Third people's Hospital of Henan Province,Zhengzhou,Henan 450006,China;Department of Interventional Radi-ology,The Third people's Hospital of Henan Province,Zhengzhou,Henan 450006,China)

机构地区：[1]河南省直第三人民医院肝胆外科,河南郑州450006 [2]河南省直第三人民医院消化病中心,河南郑州450006 [3]河南省直第三人民医院放射介入科,河南郑州450006

出　　处：《安徽医药》2022年第4期819-823,共5页Anhui Medical and Pharmaceutical Journal

基　　金：2019年度河南省医学科技攻关计划联合共建项目(LHGJ20190855)。

摘　　要：目的 探讨术前口服碳水化合物对胆囊结石微创手术围术期应激反应及术后胃肠功能恢复的影响。方法 对河南省直第三人民医院2019年6月至2020年4月收治的71例胆囊结石实施腹腔镜下胆囊切除术病人临床资料进行回顾性分析,其中有34例术前未口服碳水化合物(记为常规组),余37例术前口服碳水化合物(记为饮品组)。对比术前6 h、术前即刻、术后即刻、术后12 h、术后72 h应激反应指标变化[包括血清皮质醇(Cor)、血糖(Glu)、C反应蛋白(CRP)],术后肠鸣音恢复时间、首次排气时间、首次排便时间,术前6 h、术后12 h血清胃动素(MTL)、胃泌素-17(G-17)、生长抑素(SS)水平变化,术后3 d内恶心、呕吐、腹胀发生率,术后并发症。结果 常规组术前即刻、术后即刻、术后12 h、术后72 h Cor分别为(159.58±20.36)mg/L、(168.75±23.39)mg/L、(198.97±32.45)mg/L、(182.73±22.40)mg/L,Glu分别为(5.29±0.44)mmol/L、(6.15±0.68)mmol/L、(8.95±1.25)mmol/L、(7.20±0.72)mmol/L,CRP分别为(26.74±4.61)mg/L、(46.83±5.96)mg/L、(109.43±12.58)mg/L、(84.69±11.54)mg/L;饮品组术前即刻、术后即刻、术后12 h、术后72 h Cor分别为(143.07±19.85)mg/L、(155.71±22.56)mg/L、(175.40±26.71)mg/L、(140.93±21.06)mg/L,Glu分别为(4.52±0.49)mmol/L、(5.85±0.56)mmol/L、(7.10±0.88)mmol/L、(4.52±0.49)mmol/L,CRP分别为(11.08±2.05)mg/L、(30.12±5.12)mg/L、(76.54±10.30)mg/L、(11.33±2.02)mg/L。两组术后即刻、术后12 h Cor、Glu、CRP水平均高于术前6 h,且常规组术前即刻、术后72 h均高于术前6 h,术后即刻、术后12 h、术后72 h均高于术前即刻,术后12 h、术后72h均高于术后即刻,术后72 h均低于术后12 h;饮品组术后即刻、术后12 h均高于术前即刻,术后12 h均高于术后即刻,术后72h均低于术后即刻和术后12 h,均差异有统计学意义(P<0.05);饮品组术前即刻、术后即刻、术后12 h、术后72 h应激反应指标均低于常规组,均差异有统计�Objective To explore the effect of oral carbohydrate before operation on perioperative stress response and gastrointestinal function recovery after minimally invasive cholecystolithiasis surgery.Methods The clinical data of 71 patients with cholecystolithiasis who underwent laparoscopic cholecystectomy in the Third people’s Hospital of Henan Province from June 2019 to April 2020were analyzed retrospectively.Among them,34 patients did not take carbohydrates before operation (recorded as group A),and 37 patients took carbohydrates before operation (recorded as group B).The changes of stress response indexes[including serum cortisol(COR),glucose (Glu),C reactive protein (CRP)]were compared at 6 h before operation,immediately after operation,12 h after operation and 72 h after operation,the recovery time of bowel sounds,the time of first exhaust,the time of first defecation,the changes of serum motilin (MTL),gastrin-17 (G-17) and somatostatin (SS) were observed at 6 h before operation and 12 h after operation,and the incidences of nausea,vomiting,abdominal distention,and complications were observed at 3 d after operation.Results The levels of Cor in group A immediately before operation,immediately after operation,at 12 h after operation and at 2 h after operation were (159.58±20.36) mg/L,(168.75±23.39) mg/L,(198.97±32.45) mg/L,(182.73±22.40) mg/L respectively,and the levels of Glu were (5.29±0.44)mmol/L,(6.15±0.68) mmol/L,(8.95±1.25) mmol/L,(7.20±0.72) mmol/L respectively,and the levels of CRP were (26.74±4.61) mg/L,(46.83±5.96) mg/L,(109.43±12.58) mg/L,(84.69±11.54) mg/L respectively.The levels of Cor in group B immediately before operation,immediately after operation,at 12 h after operation and at 2 h after operation were (143.07±19.85) mg/L,(155.71±22.56) mg/L,(175.40±26.71) mg/L,(140.93±21.06) mg/L respectively,and the levels of Glu were (4.52±0.49) mmol/L,(5.85±0.56) mmol/L,(7.10±0.88) mmol/L,(4.52±0.49) mmol/L respectively,and the levels of CRP were (11.08±2.05) mg/L,(30.12±5.12) mg/L,(7

关 键 词：胆囊切除术 腹腔镜 术前用药法 碳水化合物 胆囊结石 应激反应 胃肠功能 

分 类 号：R657.4[医药卫生—外科学]