Academic Department of Surgery, University Hospital and Faculty of Medicine Hradec Králové, Czech Republic.
Wien Klin Wochenschr. 2010 Jan;122(1-2):23-30. doi: 10.1007/s00508-009-1291-7.
Increasing evidence suggests that preoperative fasting, as was the clinical practice for many decades, might be associated with untoward consequences and that a standardized preoperative intake of nutrients might be advantageous; this is a component of the enhanced recovery after surgery (ERAS) concept. Thus, in a randomized controlled trial we compared preoperative fasting with preoperative preparation with either oral or intravenous intake of carbohydrates, minerals and water. Biochemical, psychosomatic, echocardiographic and muscle-power parameters were assessed in surgical patients with colorectal diseases during the short-term perioperative period. We also assessed the safety of peroral intake shortly before surgery.
A total of 221 elective colorectal surgery patients in this bicentric, randomized, prospective and blinded clinical trial were divided into three groups: A - patients fasting from midnight (control group); B - patients supported preoperatively by glucose, magnesium and potassium administered intravenously; C - patients supported preoperatively by oral consumption of a specifically composed solution (potion).
The general perioperative clinical status of patients in groups C and B was significantly better than those in group A. Psychosomatic conditions postoperatively were found to be best in group C (P < 0.029). The rise in the index of insulin resistance (QUICKI) from the preoperative to the postoperative state was significant in group A (P < 0.05). The systolic and diastolic function of the left ventricle improved postoperatively in group C vs. group A (P < 0.04), and the ejection fraction was also significantly higher postoperatively in group C vs. group A (P < 0.03). The gastric residual volume was 5 ml and the pH of stomach juice was 3.5-5 in all groups without statistically significant difference. No difference was found in the length of hospital stay or the rate of complications.
Preoperative fasting does not confer any benefit or advantage for surgical patients. In contrast, consumption of an appropriate potion composed of water, minerals and carbohydrates offers some protection against surgical trauma in terms of metabolic status, cardiac function and psychosomatic status. Peroral intake shortly before surgery did not increase gastric residual volume and was not associated with any risk.
越来越多的证据表明，术前禁食（几十年来的临床实践）可能会带来不良后果，而标准化的术前营养摄入可能是有益的；这是术后加速康复（ERAS）概念的一个组成部分。因此，我们在一项随机对照试验中比较了术前禁食与术前口服或静脉输注碳水化合物、矿物质和水的准备。在短期围手术期内，对患有结直肠疾病的手术患者进行了生化、身心、超声心动图和肌肉力量参数评估。我们还评估了手术前短时间口服摄入的安全性。
这项双中心、随机、前瞻性、盲法临床试验共纳入 221 例择期结直肠手术患者，分为三组：A 组 - 患者午夜开始禁食（对照组）；B 组 - 患者术前静脉输注葡萄糖、镁和钾支持；C 组 - 患者术前口服专门配制的溶液（药水）支持。
C 组和 B 组患者的整体围手术期临床状况明显优于 A 组。术后身心状况在 C 组最佳（P < 0.029）。与术前相比，A 组的胰岛素抵抗指数（QUICKI）升高具有统计学意义（P < 0.05）。与 A 组相比，C 组术后左心室收缩和舒张功能均有所改善（P < 0.04），且术后 C 组射血分数也明显高于 A 组（P < 0.03）。三组胃残留量均为 5ml，胃液 pH 值为 3.5-5，差异无统计学意义。住院时间和并发症发生率无差异。
术前禁食对手术患者没有任何益处或优势。相比之下，饮用适当的水、矿物质和碳水化合物组成的药水可以在代谢状态、心脏功能和身心状况方面为手术创伤提供一些保护。手术前短时间口服摄入不会增加胃残留量，也没有任何风险。
