术前口服碳水化合物负荷:对术中血糖水平、术后恶心呕吐及重症监护病房住院时间的影响。
Preoperative oral carbohydrate loading: Effects on intraoperative blood glucose levels, post-operative nausea and vomiting, and intensive care unit stay.
作者信息
Rajan Sunil, Rahman Ahlam Abdul, Kumar Lakshmi
机构信息
Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
出版信息
J Anaesthesiol Clin Pharmacol. 2021 Oct-Dec;37(4):622-627. doi: 10.4103/joacp.JOACP_382_19. Epub 2022 Jan 6.
BACKGROUND AND AIMS
Preoperative fasting imparts safety to patients from aspiration of gastric contents, but undue fasting may predispose to hypoglycemia and dehydration. Preoperative carbohydrate drink reduces postoperative nausea and vomiting (PONV). Primary objective of the present study was to assess effect of carbohydrate drink given 2h before surgery on intraoperative blood glucose levels as compared to those who did not receive it. Secondary objectives included assessment of incidence and severity of PONV and duration of Intensive Care Unit (ICU) stay.
MATERIAL AND METHODS
It was a prospective randomized study done in 52 non-diabetic patients undergoing thyroidectomy. Group A received 39gm of carbohydrate in 250 mL of apple juice (tetrapack) and Group B patients were given equivalent volume of plain water 2 h prior to surgery. Random blood glucose (RBS) levels were checked before fluid administration, preinduction, 1 h postinduction, and at the end of surgery. PONV was assessed using PONV Impact Scale Score (ISS) and rescue drugs, if needed, were noted. Paired -test, sample -test, Mann-Whitney test, and Fisher's exact test were used as applicable.
RESULTS
The fasting, preinduction, and postoperative RBS values were comparable in both groups. Group B had significantly higher RBS at 1h intraoperatively. Group A patients had less vomiting, dry retching, or nausea and required less rescue therapy compared to Group B.
CONCLUSION
Compared to patients who received carbohydrate drink 2 h before surgery, those who did not receive it had significantly higher blood glucose values intraoperatively with a higher incidence and severity of PONV and comparable ICU stay.
背景与目的
术前禁食可确保患者免受胃内容物误吸的影响,但禁食时间过长可能导致低血糖和脱水。术前饮用碳水化合物饮料可减少术后恶心和呕吐(PONV)。本研究的主要目的是评估术前2小时饮用碳水化合物饮料与未饮用者相比,对术中血糖水平的影响。次要目的包括评估PONV的发生率和严重程度以及重症监护病房(ICU)住院时间。
材料与方法
这是一项针对52例接受甲状腺切除术的非糖尿病患者进行的前瞻性随机研究。A组在术前2小时饮用250毫升苹果汁(利乐包装)中含39克碳水化合物,B组患者术前2小时饮用等量的白开水。在给予液体前、诱导前、诱导后1小时和手术结束时检查随机血糖(RBS)水平。使用PONV影响量表评分(ISS)评估PONV,如有需要,记录使用的解救药物。根据适用情况使用配对t检验、样本t检验、曼-惠特尼检验和费舍尔精确检验。
结果
两组的禁食、诱导前和术后RBS值具有可比性。B组术中1小时的RBS显著更高。与B组相比,A组患者的呕吐、干呕或恶心较少,所需的解救治疗也较少。
结论
与术前2小时饮用碳水化合物饮料的患者相比,未饮用者术中血糖值显著更高,PONV的发生率和严重程度更高,ICU住院时间相当。