文章摘要
术前口服能量合剂在下肢关节置换手术中的应用
Application of preoperative oral energy mixture in lower limb joint replacement surgery
  
DOI：10.12089/jca.2019.03.006
中文关键词: 术前  口服  能量合剂  关节置换  血糖  电解质
英文关键词: Preoperative  Oral administration  Energy mixture  Joint replacement  Blood glucose  
基金项目:国家自然科学基金项目（81471106）；湖南省自然科学基金项目（2017JJ3445）
作者单位E-mail
邱丽萍 410011,长沙市,中南大学湘雅二医院麻醉科  
毛新展 中南大学湘雅二医院骨科  
王皓崧 410011,长沙市,中南大学湘雅二医院麻醉科  
钟锋 410011,长沙市,中南大学湘雅二医院麻醉科  
戴茹萍 410011,长沙市,中南大学湘雅二医院麻醉科  
张燕玲 410011,长沙市,中南大学湘雅二医院麻醉科 zhangyanling0618@aliyun.com 
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中文摘要:
      
目的 探讨术前口服能量合剂对全麻下择期行下肢关节置换手术患者安全性、舒适性的影响，为术前快速康复外科（ERAS）提供参考。
方法 选择择期全麻下行关节置换手术的患者51例，男24例，女27例，年龄18~65岁, BMI 18.9~23.6 kg/m2，ASA Ⅰ—Ⅲ级。随机分为能量合剂组（EM组，n=16）、糖盐组（GN组，n=17）、空白组（N组，n=18）。EM组和GN组术前1 d 22：00后开始禁食， 术前2 h EM组口服能量合剂（术能）5 ml/kg，GN组口服5%糖盐水5 ml/kg。N组术前1 d 22：00点开始禁食，午夜后开始禁水。记录三组患者手术当日晨7：00（饮用前）、饮用后1、2 h或同时段的胃窦残余容量面积（CSA）。评估三组饮用前、饮用后1 h、麻醉诱导前饥饿评分和口渴评分；EM组和GN组对口服饮料的口感评分。检测并记录患者术前1 d、入室时、术后2 h血糖（Glu）、电解质（Na+、K+、Ca2+）。记录术后恶心呕吐等不良反应发生情况。
结果 饮用后1 h EM组和GN组CSA均明显大于N组（P<0.05）；饮用前、饮用后2 h 三组CSA差异无统计学意义。饮用后1 h和麻醉诱导前EM组和GN组饥饿评分和口渴评分明显低于N组（P<0.05），EM组口渴评分明显低于GN组（P<0.05）。EM组口感评分明显高于GN组（P<0.05）。与术前1d比较，入室时、术后2 h N组Glu明显升高（P<0.05），Na+明显升高（P<0.05）。三组患者均未见术后恶心呕吐等不良反应。
结论 术前2 h口服能量合剂（术能）对择期全麻下行下肢关节置换手术患者是安全的，能明显缓解患者术前饥饿、口渴等不适感，且口感易被接受，能维持患者围术期血糖、电解质的稳定，更利于患者术后快速康复。
英文摘要:
      
Objective To investigate the effect of preoperative oral energy mixture on the safety and comfort of patients with selective lower limbs joint replacement under general anesthesia and provide scientific evidence for preoperative ERAS.
Methods Fifty one patients with selective general anesthesia underwent joint replacement surgery, 24 males and 27 females, aged 18 - 65 years, BMI 18.9 - 23.6 kg/m2, ASA physical status Ⅰ-Ⅲ, were randomly allocated to Group energy mixture (group EM，n = 16) , Group sugar salt (group GN，n = 17) and Group Blank (group N，n = 18). Group EM and group GN began fasting after 22:00 one day before operation. Energy mixture (5 ml/kg) and 5% sugar salt (5 ml/kg) were taken 2 h before operation separately. Group N began fasting one day before operation from 22:00 and water deprivation overnight. The gastric emptying was evaluated by measuring cross section area (CSA) of sinuses ventriculi at 7:00 on the day of surgery for three groups and 1, 2 h after drinking for group EM and group GN. The taste, hunger and thirsty were recorded by visual analogue scale (VAS), The blood glucose (Glu) and electrolytes（Na+，K+，Ca2+） 1 day before surgery, entering the operating room, and 2 h after surgery were detected. The occurrence of adverse reactions such as postoperative nausea and vomiting was recorded.
Results Compared with group N, the CSA of gastric antrum was significantly increased in groups EM and GN at 1 hour after drinking (P < 0.05). There was no significant difference in CSA at before drinking and 2 h after drinking. The VAS scores of hunger and thirst between group EM and GN were significantly lower than those in group N 1 h after drinking and before anesthesia induction (P < 0.05).The VAS scores of taste of group EM was significantly higher than that of group GN (P < 0.05). Compared with 1 day before surgery, blood glucose and Na+ levels was significantly higher at entering the operating room and 2 h after surgery in group N (P<0.05). No adverse reactions such as postoperative nausea and vomiting were observed in three groups.
Conclusion Preoperative oral energy mixture administration 2 h before operation is safe for patients with selective lower limbs joint replacement under general anesthesia. It can reduce patients discomfort in hunger and thirst before operation, relieve pre-operative hunger, thirst and other discomfort significantly and the taste is easy to be accepted by patients. It is more conducive to the stability of blood glucose, electrolytes and rapid postoperative recovery.
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