Safe eating time of patients undergoing general anesthesia
video-assisted thoracoscopic pulmonary resection under concept of enhanced
recovery after surgery

doi:10.3760/cma.j.issn.1007-1245.2022.11.031

Abstract

Abstract: Objective　To explore the safe eating time of patients undergoing general anesthesia video-assisted thoracoscopic (VATS) pulmonary resection under the concept of enhanced recovery after surgery (ERAS). Methods　From August 2020 to August 2021, a total of 240 patients who underwent VATS pulmonary resection at Department of Thoracic Surgery, First Affiliated Hospital, Guangzhou Medical University were divided into a study group and a control group by the random number table method, with 120 cases in each group. The study group ate the first time 2 hours after the surgery, and the control group 6 hours after. The prealbumin and albumin levels before and after the surgery, anal exhaust times, and incidences of cough, nausea, vomiting, diarrhea, and pulmonary infection were compared between the two groups. The t and χ² test were used for the analysis. Results　Thirty-four patients withdrew from the trial because they could not operate on time or were converted to thoracotomy, and 206 completed the trial. There were 116 cases in the study group, including 66 males and 50 females, and they were (62.33±12.77) years old. There were 90 cases in the control group, including 54 males and 36 females, and they were (60.19±13.28) years old. The levels of prealbumin and albumin on day 2 after the surgery in the study group were significantly higher than those in the control group [(279.2±75.3) mg/L vs. (248.8±67.8) mg/L and (38.6±8.3) g/L vs. (35.9±6.2) g/L], with statistical differences (t=3.001 and 2.578; P=0.003 and 0.011). The postoperative exhaust time in the study group was shorter than that in the control group[(24.8±11.0) h vs. (31.2±12.3) h], with a statistical difference (t=3.933, P<0.001). There was no statistical difference in the incidence of complications, such as choking, nausea, vomiting, diarrhea, and pulmonary infection, between the two groups (P>0.05). Conclusions　It is safe and feasible for patients undergoing VATS pulmonary resection under the concept of ERAS to eat within 2 hours after operation, without increasing the incidences of coughing, nausea, vomiting, diarrhea, and pulmonary infection. It is worthy of clinical promotion for the improvement of the patients' nutritional status and the promotion of their gastrointestinal function recovery.

Key words: Enhanced recovery after surgery, Video-assisted thoracoscopic pulmonary resection, Surgery under general anesthesia, Early feeding

摘要： 目的　探讨加速康复外科理念（enhanced recovery after surgery，ERAS）下全身麻醉电视辅助胸腔镜（video-assisted thoracoscopic surgery，VATS）肺部切除术患者术后早期安全进食的时间。方法　选择2020年8月至2021年8月在广州医科大学附属第一医院胸外科行VATS肺部切除术的240例患者为研究对象，采用随机数字表法分为研究组和对照组，各120例。研究组术后2 h首次进食，对照组术后6 h首次进食。比较两组患者术后前白蛋白、白蛋白水平，术后肛门排气时间，呛咳、恶心、呕吐、腹泻以及肺部感染发生率。采用t检验、χ²检验进行分析。结果　因不能按时手术或中途转开胸的34例患者退出试验，206例完成试验。研究组116例，其中男66例，女50例，年龄（62.33±12.77）岁；对照组90例，其中男54例，女36例，年龄（60.19±13.28）岁。研究组术后第2天的前白蛋白、白蛋白水平分别为（279.2±75.3）mg/L、（38.6±8.3）g/L，均明显高于对照组［分别为（248.8±67.8）mg/L、（35.9±6.2）g/L］，两组比较差异均有统计学意义（t=3.001、2.578，P=0.003、0.011）；研究组术后排气时间早于对照组［（24.8±11.0）h比（31.2±12.3）h］，差异有统计学意义（t=3.933，P<0.001）；两组患者呛咳、恶心、呕吐、腹泻以及肺部感染等并发症发生率情况比较，差异无统计学意义（P>0.05）。结论　ERAS理念下全身麻醉VATS肺部切除术患者术后2 h内进食是安全可行的，不会增加呛咳、恶心、呕吐、腹泻以及肺部感染发生率，并可以改善患者营养状况，促进胃肠功能恢复，值得临床推广。

关键词: 加速康复外科理念, 电视辅助胸腔镜肺部切除术, 全身麻醉手术, 早期进食

Dong Min, Guo Wenwei, Liu Hui, Zeng Qiuxuan. Safe eating time of patients undergoing general anesthesia video-assisted thoracoscopic pulmonary resection under concept of enhanced recovery after surgery[J]. International Medicine and Health Guidance News, 2022, 28(11): 1610-1614.

董敏, 郭文巍, 刘辉, 曾秋璇. 加速康复外科理念下全麻电视辅助胸腔镜肺部切除术患者安全进食时间的探讨[J]. 国际医药卫生导报, 2022, 28(11): 1610-1614.

References

[1] 郑荣寿,孙可欣,张思维,等.2015年中国恶性肿瘤流行情况分析[J].中华肿瘤杂志,2019,41(1):19-28.DOI:10.3760/cma.j.issn.0253-3766.2019.01.008.

[2] Hoy H, Lynch T, Beck M. Surgical treatment of lung cancer[J]. Crit Care Nurs Clin North Am, 2019,31(3):303-313. DOI: 10.1016/j.cnc.2019.05.002.

[3] Grant MC, Yang D, Wu CL, et al. Impact of enhanced recovery after surgery and fast track surgery pathways on healthcare-associated infections: results from a systematic review and meta-analysis[J]. Ann Surg, 2017,265(1):68-79. DOI: 10.1097/SLA.0000000000001703.

[4] 李士红.加速康复外科理念在普外科围术期护理中的应用现状与展望[J].齐鲁护理杂志,2019,25(4):1-4.DOI:10.3969/j.issn.1006-7256.2019.04.001.

[5] 中华医学会外科学分会,中华医学会麻醉学分会.加速康复外科中国专家共识及路径管理指南(2018版)[J].中国实用外科杂志,2018,38(1):1-20.DOI:10.19538/j.cjps.issn1005-2208.2018.01.01.

[6] 劳贤邦,庞德春,纪建波,等.两种苏醒评分方法对麻醉复苏效果影响的比较[J].护士进修杂志,2016,31(11):1043-1045.DOI:10.16821/j.cnki.hsjx.2016.11.032.

[7] 王娇,陈筱诗,蒋琦,等.洼田饮水试验用于评估全身麻醉患者术后早期进水可行性的研究[J].国际麻醉学与复苏杂志,2021,42(11):1199-1201.DOI:10.3760/cma.j.cn321761- 20201122-00417.

[8] 许春妮,陈红,周炎.肿瘤合并贫血患者血清前白蛋白检测的临床意义[J].医学综述,2014,20(9):1725-1727.DOI:10.3969/j.issn.1006-2084.2014.09.069.

[9] 詹陈菊,王美,刘琪希,等.四肢骨折全麻术后患者早期进食的实证研究[J].护理学杂志,2017,32(8):54-56.DOI:10.3870/j.issn.1001-4152.2017.08.054.

[10] Arslantas MK, Kara HV, Tuncer BB, et al. Effect of the amount of intraoperative fluid administration on postoperative pulmonary complications following anatomic lung resections[J]. J Thorac Cardiovasc Surg, 2015,149(1):314-320. DOI: 10.1016/j.jtcvs.2014.08.071.

[11] 王会东,冀晋杰,徐学敏,等.麻醉期间目标导向液体治疗对肺叶切除术后急性肺损伤的影响[J].解放军医学院学报,2015,36(11):1109-1112.DOI:10.3969/j.issn.2095-5227. 2015.11.014.

[12] Lobo DN. Randomized clinical trial of fluid and salt restriction compared with a controlled liberal regimen in elective gastrointestinal surgery [J]. Br J Surg, 2013,100(13):1746-1747. DOI: 10.1002/bjs.9300.

[13] 唐煜东,梅小丽,郑娥,等.胸部肿瘤术后患者不良情绪现状及影响因素分析[J].中国胸心血管外科临床杂志,2018,25(1):67-70.DOI:10.7507/1007-4848.201706026.

[14] 王华英,姚依坤,孙晓静.加速康复外科护理模式对剖宫产术后恢复的影响[J].护理研究,2021,35(5):905-907.DOI:10.12102/j.issn.1009-6493.2021.05.026.

[15] 杨麦兰,廖理芳,侯福伟,等.融入加速康复外科理念的临床护理路径在老年胃癌围手术期护理中的应用[J].中国实用护理杂志,2022,38(2):87-92.DOI:10.3760/cma.j.cn211501-20201128-04665.

[16] Li P, Li J, Lai Y, et al. Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: a retrospective cohort study[J]. J Thorac Dis, 2018,10(10):5755-5763. DOI: 10.21037/jtd.2018.09.113.

[17] 王烺,孙耕耘.腹部手术后肺部并发症相关危险因素分析[J].临床肺科杂志,2010,15(5):612-614.DOI:10.3969/j.issn.1009-6663.2010.05.007.

[18] Leslie K, Peyton PJ, Story DA. Risk of postoperative pulmonary complications: comment[J]. Anesthesiology, 2021,135(5):928-930. DOI: 10.1097/ALN.0000000000003978.

[19] Boitano TKL, Smith HJ, Rushton T, et al. Impact of enhanced recovery after surgery (ERAS) protocol on gastrointestinal function in gynecologic oncology patients undergoing laparotomy[J]. Gynecol Oncol, 2018,151(2):282-286. DOI: 10.1016/j.ygyno.2018.09.009.

[20] 中华医学会外科学分会,中华医学会麻醉学分会.加速康复外科中国专家共识暨路径管理指南(2018)[J].中华麻醉学杂志,2018,38(1):8-13.DOI:10.3760∕cma.j.issn.0254-1416.2018.01.003.

[21] 张艳平,金姬延,刘东晖,等.腰椎后路减压融合内固定术加速康复外科对骨科护士护理的知识、信念和行为的效果分析[J].中国微创外科杂志,2021,21(2):139-144.DOI:10.3969/j.issn.1009-6604.2021.02.010.

[22] Tsukamoto M, Hitosugi T, Yokoyama T. Influence of fasting duration on body fluid and hemodynamics[J]. Anesth Prog, 2017,64(4):226-229. DOI: 10.2344/anpr-65-01-01.

[23] 金姬延.加速康复外科理念下术前禁食管理的发展现状[J].中国微创外科杂志,2019,19(4):360-362.DOI:10.3969/j.issn.1009-6604.2019.04.017.

[24] 王旖磊,胡雁.上海市三级医院护士循证护理能力现况及影响因素分析[J].中国实用护理杂志,2017,33(11):867-871.DOI:10.3760/cma.j.issn.1672-7088.2017.11.017.

[25] Cassidy MR, Rosenkranz P, McCabe K, et al. I COUGH: reducing postoperative pulmonary complications with a multidisciplinary patient care program[J]. JAMA Surg, 2013,148(8):740-745. DOI: 10.1001/jamasurg.2013.358.

[26] 杨桦.加速康复外科时代的围术期营养支持治疗[J].中华消化外科杂志,2017,16(12):1176-1179.DOI:10.3760/cma.j.issn.1673-9752.2017.12.003.

[27] 刁齐翔,陈玉红.手术后患者口渴的护理研究进展[J].护理学杂志,2017,32(22):106-110.DOI:10.3870/j.issn.1001- 4152. 2017.22.106.

[28] 黄燕群,罗敏.人性化管理联合舒适护理在普外手术患者的疗效观察[J].国际医药卫生导报,2020,26(16):2469-2471.DOI:10.3760/cma.j.issn.1007-1245.2020.16.044.

[29] 贾怡童,罗芳."舒适化医疗"的发展与医学伦理学的关系[J].医学与哲学,2017,38(10):86-88.DOI:10.12014/j.issn.1002- 0772.2017.05b.24.

Safe eating time of patients undergoing general anesthesia video-assisted thoracoscopic pulmonary resection under concept of enhanced recovery after surgery

加速康复外科理念下全麻电视辅助胸腔镜肺部切除术患者安全进食时间的探讨

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