Teoh W H L, Shah M K, Mah C L
Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
Singapore Med J. 2007 Feb;48(2):152-7.
We prospectively investigated the incidence of ileus, nausea/vomiting, and hospital course of non-labouring women fed immediately after Caesarean delivery under regional anaesthesia.
196 patients were randomised into either the early-fed group (250 ml clear fruit juice 30 minutes postoperatively, and unlimited solid food thereafter) or the control group (clear feeds allowed after two hours, advanced to solids as tolerated).
Both groups had similar baseline demographics and operative characteristics. Bowel sounds were present immediately postoperatively in 90.8 percent (early group) versus 95.9 percent (control). The early-fed group had reduced time to first drink (0.86 +/- 0.6 hours versus 14.4 +/- 18.2 hours) and solid food intake (4.2 +/- 2.7 hours versus 20.0 +/- 6.8 hours), earlier passage of flatus (14.4 +/- 9.4 hours versus 21.0 +/- 10.4 hours) and first stool (44.4 +/- 18.7 hours versus 65.6 +/- 25.4 hours), shorter duration of intravenous hydration (12.8 +/- 7.5 hours versus 22.4 +/- 5.8 hours), and earlier removal of intravenous cannulae (20.5 +/- 6.7 hours versus 24.7 +/- 7.8 hours), with all p-values less than 0.001. Early-fed mothers also mobilised (23.1 +/- 6.8 hours versus 27.4 +/- 7.6 hours), commenced breastfeeding (26.5 +/- 14.1 hours versus 38.8 +/- 21.8 hours), and were ready for discharge earlier (44.3 +/- 10.4 hours versus 62.0 +/- 12.7 hours), compared to the control group, with all p-values less than 0.001. There was no difference in mild ileus symptoms (3.1 percent). Earlier solid intake resulted in more nausea (10.2 percent versus 2 percent, p-value is 0.033), which was self-limiting. Maternal satisfaction rated higher in the early-fed group (90 versus 60, on visual analogue scale score 0-100, p-value is less than 0.001).
This prospective randomised trial showed no increase in ileus with early feeding post-Caesarean delivery under spinal anaesthesia, with added benefits of earlier intravenous cannulae removal, ambulation, breastfeeding initiation and potential for shorter hospitalisation. Despite increased nausea in those taking solids earlier (but not feeds), maternal satisfaction rated higher in the early-fed group.
我们前瞻性地研究了在区域麻醉下剖宫产术后立即进食的未临产妇女肠梗阻、恶心/呕吐的发生率及住院过程。
196例患者被随机分为早期进食组（术后30分钟给予250毫升清果汁，之后可自由进食固体食物）或对照组（术后两小时开始给予清流质饮食，根据耐受情况逐渐过渡到固体食物）。
两组患者的基线人口统计学特征和手术特点相似。术后即刻肠鸣音出现率在早期进食组为90.8%，对照组为95.9%。早期进食组首次饮水时间缩短（0.86±0.6小时对14.4±18.2小时）、固体食物摄入时间缩短（4.2±2.7小时对20.0±6.8小时）、首次排气时间提前（14.4±9.4小时对21.0±10.4小时）、首次排便时间提前（44.4±18.7小时对65.6±25.4小时）、静脉补液时间缩短（12.8±7.5小时对22.4±5.8小时）、静脉留置针拔除时间提前（20.5±6.7小时对24.7±7.8小时），所有p值均小于0.001。与对照组相比，早期进食的母亲活动时间提前（23.1±6.8小时对27.4±7.6小时）、开始母乳喂养时间提前（26.5±14.1小时对38.8±21.8小时）、准备出院时间提前（44.3±10.4小时对62.0±12.7小时），所有p值均小于0.001。轻度肠梗阻症状发生率无差异（3.1%）。较早摄入固体食物导致恶心发生率更高（10.2%对2%，p值为0.033），但为自限性。早期进食组产妇满意度更高（视觉模拟评分0 - 100分，分别为90分对60分，p值小于0.001）。
这项前瞻性随机试验表明，在脊麻下剖宫产术后早期进食不会增加肠梗阻的发生率，还具有提前拔除静脉留置针、活动、开始母乳喂养以及可能缩短住院时间等额外益处。尽管较早摄入固体食物（而非流质食物）的产妇恶心发生率增加，但早期进食组产妇满意度更高。
