术前碳水营养液在老年粗隆间骨折患者手术麻醉应用中的安全性研究  

Study on the safety of carbohydrates-based nutritional liquid for pre-operation use in surgical anesthesia of elderly patients with intertrochanteric fracture

作　　者：吴向荣 吕校宇 陈昌胜 周金龙 赵俊[3] 邢玲 莫宝庆 汪文娟 WU Xiang-rong;LYU Xiao-yu;CHEN Chang-sheng(Department of Anesthesiology,Gaochun Hospital Affiliated to Jiangsu University,Nanjing Jiangsu 211300,China;Committee of Elderly Nutrition in Jiangsu Association of Gerontology,Nanjing Jiangsu 210018,China;Department of Orthopaedics,Gaochun Hospital Affiliated to Jiangsu University,Nanjing Jiangsu 211300,China)

机构地区：[1]江苏大学附属高淳医院麻醉科,江苏南京211300 [2]江苏省老年学学会老年营养专业委员会,江苏南京210018 [3]江苏大学附属高淳医院骨科,江苏南京211300

出　　处：《临床和实验医学杂志》2024年第10期1110-1114,共5页Journal of Clinical and Experimental Medicine

基　　金：江苏省老年学学会老年营养健康科研基金(编号:20210809)。

摘　　要：目的研究术前碳水营养液在老年粗隆间骨折患者手术麻醉中的安全性。方法前瞻性选取2022年4月至2023年5月江苏大学附属高淳医院收治的48例年粗隆间骨折患者作为研究对象。按随机数表法将其分为干预组(n=24)和对照组(n=24)。干预组患者在术前8 h禁食固体食物,术前2 h饮用200 mL的术前碳水营养液(碳水化合物含量12.5%的特殊医学用途碳水化合物组件配方食品),对照组患者术前8 h禁食、禁饮。记录两组患者的术前、术后主观状态、胃排空状态、麻醉术中指标(麻醉时间和血气状况)以及入院时和术中的空腹血糖、胰岛素、胰岛素抵抗指数水平。结果术前,干预组口渴患者比例为0,明显低于对照组(54.2%),差异有统计学意义(P<0.05);两组心悸、恐惧、饥饿、肌肉颤抖、头晕患者比例比较,差异均无统计学意义(P>0.05)。术后,两组患者均对于麻醉手术表示满意,未出现恶心、呕吐、头晕、谵妄患者。干预组患者麻醉前胃残余量为(0.23±0.08)mL,显著低于对照组[(0.38±0.11)mL],干预组患者血液的pH值、PaCO_(2)、HCO_(3)^(-)水平分别为7.38±0.04、(43.30±2.35)mmHg、(24.63±0.52)mmol/L,均高于对照组[7.34±0.03、(41.62±2.81)mmHg、(23.70±1.41)mmol/L],差异均有统计学意义(P<0.05)。干预组患者入院时的胰岛素抵抗指数为1.94(1.4,4.9),高于对照组[0.66(0.3,1.8)],入院时和术中的胰岛抵抗指数差值为1.19(0.1,3.4),高于对照组[-0.23(-0.6,1.0)],差异均有统计学意义(P<0.05);两组入院时和术中的血糖和血清胰岛素比较,差异均无统计学意义(P>0.05)。结论术前2 h饮用200 mL术前碳水营养液在老年骨科粗隆间骨折手术的麻醉中具有较高的安全性。Objective To observe the safety of carbohydrates-based nutritional liquid for pre-operation use in surgical anesthesia of elderly patients with intertrochanteric fracture.Methods A total of 48 patients with intertrochanteric fractures admitted to Gaochun Hospital Affiliated to Jiangsu University from April 2022 to May 2023 were prospectively selected as the study subjects.They were divided into the intervention group(n=24)and the control group(n=24)according to random number table method.The patients in the intervention group were fasting from solid food for 8 hours before surgery,but drank 200 mL of carbohydrates-based nutritional liquid(special medical carbohydrate component formula with a carbohydrate content of 12.5%)for pre-operation use 2 hours before surgery;the patients in the control group were fasting and drinking-free for 8 hours before surgery.The subjective states before and after surgery,gastric emptying status,intraoperative anesthesia indicators(anesthesia time and blood gas status),the levels of fasting blood glucose,insulin,and insulin resistance index at admission and during surgery two groups were recorded.Results Before surgery,the proportion of thirsty patients in the intervention group was 0,which was significantly lower than that in the control group(54.2%),and the difference was statistically significant(P<0.05);there were no statistically significant differences in the proportion of patients with palpitations,fear,hunger,muscle tremors,and dizziness between the two groups(P>0.05).The residual volume of the intervention group before surgery was(0.23±0.08)mL,which was lower than that of the control group[(0.38±0.11)mL],the blood levels of pH,PaCO_(2),HCO_(3)^(-)were 7.38±0.04,(43.30±2.35)mmHg,and(24.63±0.52)mmol/L,respectively,which were higher than those in the control group[7.34±0.03,(41.62±2.81)mmHg,and(23.70±1.41)mmol/L],and the differences were statistically significant(P<0.05).The insulin resistance index of the intervention group patients at admission was 1.94(1.4,4.9),which

关 键 词：老年人 粗隆间骨折 碳水营养液 麻醉安全性 胃残余量 

分 类 号：R614[医药卫生—麻醉学]