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| 术前口服多维碳水化合物对老年患者全髋关节置换术围术期应激反应的影响 |
| Effect of preoperative oral multi-vitamins carbohydrate on perioperative stress response in elderly patients with total hip arthroplasty |
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| DOI：10.12089/jca.2022.10.005 |
| 中文关键词: 全髋关节置换术 老年 术能 应激反应 并发症 |
| 英文关键词: Total hip arthroplasty Aged Outfast Stress response Complications |
| 基金项目: |
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| 摘要点击次数: 1429 |
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| 中文摘要: |
目的 探讨术前口服多维碳水化合物饮品（术能）对老年患者全髋关节置换术（THA）围术期应激反应的影响。
方法 选择择期全身麻醉下行THA老年患者88例，男50例，女38例，年龄65～80岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法分为三组：对照组（C组，n=29）、温水观察组（W组，n=29）和术能观察组（O组，n=30）。C组常规术前禁饮6 h，禁食8 h；W组术前2 h口服温水5 ml/kg；O组术前2 h口服术能5 ml/kg。采集口服液体前（T0）、麻醉前10 min（T1）、入麻醉恢复室苏醒后（T2）、术后次日晨8：00（T3）静脉血检测血糖、促肾上腺皮质激素（ACTH）浓度。记录麻醉前和苏醒后的口渴评分和饥饿评分，以及反流误吸、恶心呕吐的发生情况。
结果 与O组比较，C组和W组T1时血糖浓度明显降低（P＜0.05），T2、T3时血糖及ACTH浓度明显升高（P＜0.05）。与C组比较，麻醉前W组和O组口渴评分明显降低（P＜0.05）。与O组比较，麻醉前和苏醒后C组和W组饥饿评分明显升高（P＜0.05）。三组均无反流误吸发生。三组恶心呕吐发生率差异无统计学意义。
结论 老年患者全髋关节置换术术前口服术能5 ml/kg可维持合适的血糖浓度，减轻围术期应激反应，同时减少患者麻醉前口渴和饥饿感，无反流误吸发生。 |
| 英文摘要: |
Objective To investigate the effect of preoperative oral multi-vitamins carbohydrate drink (Outfast) on perioperative stress response in elderly patients with total hip arthroplasty.
Methods Eighty-eight patients undergoing total hip arthroplasty under general anesthesia, 50 males and 38 females, aged 65-80 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly assigned into control group (group C, n = 29), warm water observation group (group W, n = 29) and Outfast observation group (group O, n = 30). Group C routinely abstained from drinking for 6 hours and fasted for 8 hours before surgery; group W was administered oral 5 ml/kg of warm water 2 hours before surgery on the basis of a routine fasting; group O was administered oral 5 ml/kg of Outfast 2 hours before surgery on the basis of a routine fasting. The venous blood was collected before liquid intake (T0), 10 min before administrate anesthesia (T1), after awakening in the post-anesthesia care unit (T2), and 8:00 a.m. the next day after surgery (T3). The blood glucose and adrenocorticotropic hormone (ACTH) concentration were detected. The thirst and hunger score before anesthesia and after awakening, and the incidence of reflux and nausea and vomiting were recorded.
Results The level of blood glucose in group O was significantly higher than in group C and group W at T1(P < 0.05), whereas the levels of blood glucose and ACTH in group O were significantly lower than in group C and group W at T2 and T3(P < 0.05). Before anesthesia the thirst scores in group W and group O were significantly lower than in group C (P < 0.05). Before anesthesia and after awakening, the hunger scores in group C and group W were significantly higher than those in group O (P < 0.05). There was no reflux in the three groups. There was no difference in the incidence of nausea and vomitig among the three groups.
Conclusion Preoperative oral Outfast 5 ml/kg in elderly patients with total hip arthroplasty is helpful to maintain blood glucose level, decrease the perioperative stress response, and reduce the thirst and hunger before anesthesia without increasing occurrence of reflux and nausea. |
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