Spitz D, Chaves G V, Peres W A F
University Center of Cancer Control, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil.
National Cancer Institute, Rio de Janeiro, Brazil.
Eur J Cancer Care (Engl). 2017 Nov;26(6). doi: 10.1111/ecc.12512. Epub 2016 Apr 26.
To assess perioperative care in patients undergoing abdominal surgery for gynaecological tumours and how it relates to post-operative (PO) complications and oral PO feeding. Ninety-one women undergoing major abdominal surgery for gynaecological tumours were enrolled. Data included mechanical bowel preparation (MBP), prescribed diet, length of fast, start date of oral diet and progression of food consistency, anaesthetic technique, use of opioids and intravenous hydration (IH). Outcomes evaluated were nausea, vomiting and abdominal distension. The median pre-operative length of fast was 11.4 h. PO digestive complications occurred in 46.2% of the patients. Median intraoperative total IH and crystalloids were significantly higher in patients with abdominal distension during the first and second PO day. MBP with mannitol implied greater intraoperative IH and was significantly associated with a higher incidence of immediate PO nausea. Post-operative IH was also associated with gastrointestinal complications. The best cut-off point for the cumulative fluid load PO for determining a longer PO hospital stay was 4 L. Performing MBP before surgery and excessive IH are factors related to major digestive complications in our study population. Changes in pre-operative fasting time and PO refeeding should be considered to reduce the gastrointestinal complications and PO recovery time.
评估接受妇科肿瘤腹部手术患者的围手术期护理，以及其与术后（PO）并发症和口服PO喂养的关系。纳入91例接受妇科肿瘤大型腹部手术的女性。数据包括机械性肠道准备（MBP）、规定饮食、禁食时间、口服饮食开始日期和食物稠度进展、麻醉技术、阿片类药物使用和静脉补液（IH）。评估的结果为恶心、呕吐和腹胀。术前禁食时间中位数为11.4小时。46.2%的患者发生PO消化并发症。在术后第1天和第2天出现腹胀的患者中，术中总IH和晶体液中位数显著更高。使用甘露醇进行MBP意味着术中IH更多，且与PO即刻恶心的更高发生率显著相关。术后IH也与胃肠道并发症有关。确定PO住院时间延长的累积液体负荷PO的最佳切点为4L。在我们的研究人群中，术前进行MBP和过度IH是与主要消化并发症相关的因素。应考虑改变术前禁食时间和PO重新喂养，以减少胃肠道并发症和PO恢复时间。
