摘要
目的探讨快速康复理念下术前禁食方式对择期手术的胃癌患者安全性、舒适度、术后胰岛素抵抗和术后康复的影响。方法选取2017年5月至2018年5月间中国医学科学院肿瘤医院收治的86例择期手术的胃癌患者,采用方便抽样法将2017年5月至2017年10月间选取的46例患者纳入试验组,2017年11月至2018年5月间选取的40例患者纳入对照组。试验组患者采用快速康复理念进行护理,对照组患者采用传统护理方法,比较两组患者的术中、术后情况和主观舒适度。结果两组患者的术前胃液残留、术后下床时间及术后肛门排气时间比较,差异均无统计学意义(均P> 0. 05)。试验组患者总住院天数短于对照组患者,差异有统计学意义(P <0. 05)。术前1天,两组患者的空腹血糖、空腹胰岛素及稳态模式评估法比较,差异均无统计学意义(均P> 0. 05)。术后第1天,两组患者上述三项指标均明显升高,且对照组升高更显著,组间组内比较,差异均有统计学意义(均P <0. 05)。而术后第3天,两组患者上述各项指标均有所下降,组间比较,差异均无统计学意义(均P> 0. 05)。术前30分钟,试验组患者主观舒适度中口渴和饥饿评分低于对照组患者,差异均有统计学意义(均P <0. 05),试验组术后第一天主观舒适度中恶心、疲劳和术后第三天时腹胀较对照组减轻,差异均有统计学意义(均P <0. 05)。两组患者不良反应组间比较,差异无统计学意义(P> 0. 05)。结论快速康复理念下术前禁食方法安全可行,可改善胃癌患者术前术后舒适度和术后胰岛素抵抗,缩短住院天数。
Objective To explore the effect of preoperative fasting method based on enhanced recovery after surgery(ERAS)on insulin resistance and postoperative recovery in gastric cancer patients.Methods A total of 86 gastric cancer patients treated at Cancer Institute and Hospital,Chinese Academy of Medical Sciences from May 2015 to May 2018 were selected.Forty-six patients selected from May 2017 to October 2017 were included in the intervention group and 40 patients selected from November 2017 to May2018 were included in the control group.Patients in intervention group was given nursing based on ERAS.The control group was given traditional nursing.Results There was no significant difference in preoperative gastric juice residue,postoperative out-of-bed time and postoperative flatus between two groups(all P>0.05).The overall hospital stay was shorter in the observation group than in the control group(P<0.05).At one day before the surgery,there was no significant difference in the level of fasting blood glucose and fasting insulin and HOMA-IR(P>0.05).At one day after the surgery,the above levels were increased obviously with the control group higher than the control group(all P<0.05).At 3 days after the surgery,the above levels decreased in both group and there was no significant difference in the the levels between the two groups(P>0.05).At 30 minutes before the surgery,thirst and hunger scores were lower in the observation group than in the control group(all P<0.05).At one day after the surgery,nausea and fatigue and bloating at three days after the surgery were lower in the observation group than in the control group(all P<0.05).There was no significant difference in adverse reactions between the two groups(P>0.05).Conclusion New fasting method based on ERAS can improve patients’pre-and post-operatiive comfort,and postoperative insulin resistance,and shorten hospital stay.
作者
闫红霞
王颖
徐泉
李琦
YAN Hong-xia;WANG Ying;XU Quan;LI Qi(Department of Gastrointestinal and Pancreatic Surgery,Cancer Institute and Hospital,Chinese Academy of Medical Sciences,Beijing 100021,China)
出处
《中国肿瘤临床与康复》
2019年第4期494-497,共4页
Chinese Journal of Clinical Oncology and Rehabilitation
关键词
快速康复外科
术前禁食方法
胰岛素抵抗指数
术后康复
Enhanced recovery after surgery
Preoperative fasting method
Insulin resistance indexes
Postoperative recovery
