缩短合并糖尿病的创伤骨科患者围手术期禁食水时间的研究  

Clinical efficacy of perioperative fasting abbreviation in patients with orthopaedic trauma and diabetes mellitus

作　　者：顾航宇[1] 周雁[1] 王倩[1] 姚东晨 孙志坚 彭贵凌[1] 张春玲[1] 姜耀[1] 吴新宝[1] 李庭[1] 孙旭[1] Gu Hangyu;Zhou Yan;Wang Qian;Yao Dongchen;Sun Zhijian;Peng Guiling;Zhang Chunling;Jiang Yao;Wu Xinbao;Li Ting;Sun Xu(Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院创伤骨科,北京100035

出　　处：《中华创伤骨科杂志》2022年第7期591-597,共7页Chinese Journal of Orthopaedic Trauma

基　　金：首都卫生发展科研专项(首发2018-2-2073)。

摘　　要：目的评价缩短合并糖尿病的创伤骨科择期手术患者围手术期禁食水的疗效。方法对2019年6月至2021年6月北京积水潭医院创伤骨科收治的合并糖尿病的择期手术患者进行前瞻性非随机对照研究。将患者以病房为单位分为试验组和对照组。试验组:手术当日0 h开始禁食,术前晚进糖尿病饮食,不限制患者晚间的饮水量,术前3 h可按5 mL/kg口服本院营养科配置的浓度为6.25%的麦芽糊精果糖饮品。对照组:手术当日0 h开始禁食禁水。所有患者术后均根据苏醒评分和防御反射性评分,一旦清醒即可进无渣饮品,如无不适2 h即恢复正常饮食。记录并比较两组患者基本信息,比较实际术前禁饮时间、术前进饮总量,术后首次进饮、进食时间。观察比较两组患者围术期的主观舒适度(焦虑、口渴、饥饿、恶心、疲劳、头晕、虚汗、胃部不适等)、握力及血糖差异。观察两组患者不良反应的发生情况。结果共纳入135例患者,其中试验组52例,对照组83例。试验组男22例,女30例;年龄30~84岁。对照组男39例,女44例;年龄29~81岁。两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。试验组的术前禁饮时间[3.5(2.5,6.3)h]较对照组[12.0(9.0,16.0)h]显著缩短,术前末次饮水量[300(200,300)mL]较对照组[100(100,200)mL]显著增加,术后禁饮时间[0.08(0,1.25)h]较对照组[2.00(0,6.00)h]显著缩短、恢复正常饮食时间[2.0(2.0,2.3)h]较对照组[3.0(2.0,6.0)h]显著缩短,差异均有统计学意义(P<0.05)。试验组患者的焦虑、疲劳、虚汗和胃部不适症状在全部评估时段均显著轻于对照组,试验组患者的口渴感在术后回病房即刻比对照组显著好转,头晕和饥饿感在术前离开病房去手术室时和术后回病房即刻较对照组显著好转;试验组术后恢复进食后的恶心症状较对照组显著减轻,以上比较差异均有统计学意义(P<0.05)。试验组服无渣�Objective To evaluate the effectiveness of perioperative fasting abbreviation in traumatic patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery.Methods The patients were selected for this prospective nonrandomized controlled study who had undergone selective surgery from June 2019 to June 2021 at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital.They were divided into an intervention group and a control group according to the wards where they stayed.The intervention group was fasted for solids from 0 o'clock on the surgery day and received oral solution with 6.25%maltodextrin which had been prepared by the nutritional department 3 hours prior to surgery.The control group was fasted for either liquids or solids from the midnight before surgery.All patients were evaluated according to the wake-up score and defensive reflex score after surgery.Once they were awakened,they were allowed slag-free drinks.Normal food was allowed if there was no discomfort after 2 hours.The 2 groups were compared in terms of basic information,actual preoperative fasting time,total amount of preoperative drinking,and postoperative time for initial drinking and eating.The perioperative subjective feelings(anxiety,thirst,hunger,nausea,fatigue,dizziness,sweating,stomach discomfort,etc.),grip strength and blood glucose were observed and compared between the 2 groups.Adverse reactions in the 2 groups were also observed.Results A total of 135 patients were included,including 52 in the intervention group and 83 in the control group.The intervention group consisted of 22 males and 30 females aged from 30 to 84 years;the control group consisted of 39 males and 44 females aged from 29 to 81 years.There was no significant difference in the basic information between the 2 groups,showing comparability(P>0.05).The intervention group had significantly shorter preoperative fasting time[3.5(2.5,6.3)h versus 12.0(9.0,16.0)h],significantly higher water intake before surgery[300(200,300)mL versus 100(100,200)mL],signi

关 键 词：糖尿病 围手术期医护 禁食 禁水 创伤骨科 

分 类 号：R687.3[医药卫生—骨科学] R587.1[医药卫生—外科学]