| 朱惠刚,左艳菊,刘东升,等.术前口服碳水化合物对胆囊结石微创手术围术期应激反应及术后胃肠功能恢复的影响[J].安徽医药,2022,26(4):819-823. |
| 术前口服碳水化合物对胆囊结石微创手术围术期应激反应及术后胃肠功能恢复的影响 |
| Effect of oral carbohydrate before operation on perioperative stress response and postoperative gastrointestinal function recovery in minimally invasive cholecystolithiasis |
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| DOI：10.3969/j.issn.1009-6469.2022.04.041 |
| 中文关键词: 胆囊切除术，腹腔镜 术前用药法 碳水化合物 胆囊结石 应激反应 胃肠功能 |
| 英文关键词: Cholecystectomy, laparoscopic Premedication Carbohydrates Gallstone Stress response Gastrointestinal function |
| 基金项目:2019年度河南省医学科技攻关计划联合共建项目( LHGJ20190855) |
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| 目的探讨术前口服碳水化合物对胆囊结石微创手术围术期应激反应及术后胃肠功能恢复的影响。方法对河南省直第三人民医院 2019年 6月至 2020年 4月收治的 71例胆囊结石实施腹腔镜下胆囊切除术病人临床资料进行回顾性分析，其中有 34例术前未口服碳水化合物(记为常规组)余 37例术前口服碳水化合物(记为饮品组)。对比术前 6h、术前即刻、术后即刻、术后 12 h、术后 72 h应激反应指标变化［包括血，清皮质醇( Cor)、血糖(Glu)、 C反应蛋白( CRP)］术后肠鸣音恢复时间、首次排气时间、首次排便时间，术前 6h、术后 12 h血清胃动素( MTL)、胃泌素 -17(G-17)、生长抑素( SS)水，平变化，术后 3d内恶心、呕吐、腹胀发生率，术后并发症。结果常规组术前即刻、术后即刻、术后 12 h、术后 72 h Cor分别为( 159.58±20.36)mg/L、(168.75±23.39)mg/L、(198.97±32.45)mg/L、(182.73±22.40)mg/L，Glu分别为( 5.29±0.44)mmol/L、(6.15±0.68)mmol/L、(8.95±1.25)mmol/L、(7.20±0.72)mmol/L，CRP分别为( 26.74±4.61)mg/L、(46.83±5.96)mg/L、(109.43±12.58)mg/L、(84.69±11.54)mg/L；饮品组术前即刻、术后即刻、术后 12 h、术后 72 h Cor分别为( 143.07±19.85)mg/L、(155.71±22.56)mg/L、(175.40±26.71)mg/L、(140.93±21.06)mg/L，Glu分别为( 4.52±0.49)mmol/L、(5.85±0.56)mmol/L、(7.10±0.88)mmol/L、(4.52±0.49)mmol/L，CRP分别为(11.08±2.05)mg/L、(30.12±5.12)mg/L、(76.54±10.30)mg/L、(11.33±2.02)mg/L。两组术后即刻、术后 12 h Cor、Glu、CRP水平均高于术前 6h，且常规组术前即刻、术后 72 h均高于术前 6h，术后即刻、术后 12 h、术后 72 h均高于术前即刻，术后 12 h、术后 72 h均高于术后即刻，术后 72 h均低于术后 12 h；饮品组术后即刻、术后 12 h均高于术前即刻，术后 12 h均高于术后即刻，术后 72 h均低于术后即刻和术后 12 h，均差异有统计学意义( P<0.05)；饮品组术前即刻、术后即刻、术后 12 h、术后 72 h应激反应指标均低于常规组，均差异有统计学意义( P<0.05)；饮品组术后肠鸣音恢复时间、首次排气时间、首次排便时间均短于常规组，均差异有统计学意义［( 8.10±1.89)h比( 10.15±2.05)h，(12.20±2.12)h比( 15.45±2.25)h，(16.85±2.03)h比( 22.52±2.35)h］(P<0.05)；两组术后 12 h血清 MTL、G-17和 SS水平均下降，本组内对比差异有统计学意义( P<0.05)；术后 12 h饮品组血清 MTL、G-17和 SS水平均高于常规组，均差异有统计学意义［(221.45±30.10)pg/mL比( 182.24±27.88)pg/mL，(71.50±9.65)ng/L比( 60.33±8.74) ng/L，(46.71±5.07)ng/L比( 39.33±4.85)ng/L］(P<0.05)；饮品组腹胀发生率为 5.41%，低于常规组的 26.47%，差异有统计学意义(P<0.05)；两组术后并发症发生率差异无统计学意义( P>0.05)。结论术前口服碳水化合物可减轻胆囊结石微创手术围术期应激反应，促进胃肠功能恢复，且不会影响术后并发症。 |
| 英文摘要: |
| Objective To explore the effect of oral carbohydrate before operation on perioperative stress response and gastrointesti nal function recovery after minimally invasive cholecystolithiasis surgery.Methods The clinical data of 71 patients with cholecystoli thiasis who underwent laparoscopic cholecystectomy in the Third people's Hospital of Henan Province from June 2019 to April 2020were analyzed retrospectively. Among them, 34 patients did not take carbohydrates before operation (recorded as group A), and 37 pa tients took carbohydrates before operation (recorded as group B). The changes of stress response indexes [including serum cortisol(COR), glucose (Glu), C reactive protein (CRP)] were compared at 6 h before operation, immediately after operation, 12 h after operationand 72 h after operation, the recovery time of bowel sounds, the time of first exhaust, the time of first defecation, the changes of serummotilin (MTL), gastrin-17 (G-17) and somatostatin (SS) were observed at 6 h before operation and 12 h after operation, and the incidenc es of nausea, vomiting, abdominal distention, and complications were observed at 3 d after operation.Results The levels of Cor in group A immediately before operation, immediately after operation, at 12 h after operation and at 2 h after operation were (159.58±20.36) mg/L, (168.75±23.39) mg/L, (198.97±32.45) mg/L, (182.73±22.40) mg/L respectively, and the levels of Glu were (5.29±0.44)mmol/L, (6.15±0.68) mmol/L, (8.95±1.25) mmol/L, (7.20±0.72) mmol/L respectively, and the levels of CRP were (26.74±4.61) mg/L,(46.83±5.96) mg/L, (109.43±12.58) mg/L, (84.69±11.54) mg/L respectively. The levels of Cor in group B immediately before operation,immediately after operation, at 12 h after operation and at 2 h after operation were (143.07±19.85) mg/L, (155.71±22.56) mg/L,(175.40±26.71) mg/L, (140.93±21.06) mg/L respectively, and the levels of Glu were (4.52±0.49) mmol/L, (5.85±0.56) mmol/L, (7.10±0.88) mmol/L, (4.52±0.49) mmol/L respectively, and the levels of CRP were (11.08±2.05) mg/L, (30.12±5.12) mg/L, (76.54±10.30) mg/L, (11.33±2.02) mg/L respectively. The levels of Cor, Glu and CRP in the two groups immediately after operation, at 12 h after opera tion were higher than those at 6 h before operation, which in group A immediately before operation, at 72 h after operation were higherthan those at 6 h before operation, and those immediately after operation, at 12 h and 72 h after operation were higher than those imme diately before operation, and those at 12 h and 72 h after operation were higher than those immediately after operation, and the levels at72 h after operation were lower than those at 12 h after operation. The levels of Cor, Glu and CRP in group B immediately after opera tion, at 12 h after operation were higher than those immediately before operation, and those at 12h after operation were higher thanthose immediately after operation, and the levels at 72 h after operation were lower than those immediately after operation, at 12 h afteroperation, with statistically significant differences (P < 0.05). The stress response indexes in group B immediately before operation, im mediately after operation, at 12 h and 72 h after operation were lower than those group A, with statistically significant differences (P < 0.05). The recovery time of bowel sounds, first exhaust time and first defecation time of group B were shorter than those of group A, withstatistically significant differences [ (8.10±1.89) h vs. (10.15±2.05) h, (12.20±2.12) h vs. (15.45±2.25) h , (16.85±2.03) h vs. (22.52± 2.35) h] (P < 0.05). The levels of serum MTL, G-17 and SS in the two groups at 12 h after operation decreased, with statistically signifi cant differences (P < 0.05). The levels of serum MTL, G-17 and SS in group B at 12 h after operation were higher than those group A,with statistically significant differences [ (221.45±30.10) pg/ml vs. (182.24±27.88) pg/ml, (71.50±9.65) ng/L vs. (60.33±8.74) ng/L, (46.71±5.07) ng/L vs. (39.33±4.85) ng/L] (P < 0.05). The incidence of abdominal distention in group B was 5.41%, lower than that of 26.47% in group A (P < 0.05). There was no statistically significant difference in the complications after operation between the two groups (P > 0.05).Conclusion Oral carbohydrate before operation can reduce the stress response and promote the recovery of gastroin testinal function, without affecting the complications after operation. |
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