作　　者： (林健达）; (田珂）; (李妍）; (罗聪）; (樊俊赟）; (秦再生）;

机构地区： 南方医科大学南方医院麻醉科,广州510515

出　　处： 《中国临床医学》 2017年第3期447-450,共4页

摘　　要： 目的:观察加速康复外科(enhanced recovery after surgery,ERAS)理念下术前12h口服1 000mL、术前2h口服500mL液体碳水化合物对胃癌手术患者全麻诱导期胃内容物反流误吸及其血流动力学的影响。方法:选择60例ASAⅠ~Ⅱ级、35~70岁拟行择期腹腔镜胃癌根治术患者,随机分为两组:常规禁饮组(G组)、术前口服液体碳水化合物组(E组),每组30例。E组术前12h口服1 000mL、术前2h口服500mL液体碳水化合物。两组患者均采用丙泊酚联合瑞芬太尼静脉靶控、顺苯磺酸阿曲库铵静注全麻诱导。监测其麻醉诱导前(T0)、喉镜置入前(T_1)及插管后1min(T_2)、3min(T_3)、5min(T_4)、10min(T_5)、20min(T_6)的心率(HR)、脑电双频指数(BIS)、平均动脉压(MAP)、心排血量(CO)、心排血指数(CI)及每搏量变异度(SVV);同时观察患者全麻诱导期胃内容物反流误吸情况及胃液残留量。结果:两组T_1时的HR、BIS、MAP、CO、CI均明显低于T0时(P<0.05)。E组T_2~T_6时的SVV低于G组(P<0.05),E组T_1~T_6时的MAP、CO、CI均高于G组(P<0.05)。两组麻醉诱导过程均未发生反流误吸,E组回抽胃液残留量与G组差异无统计学意义。结论:ERAS理念下术前12h口服1 000mL、术前2h口服500mL液体碳水化合物能更好地维持择期胃癌手术患者全麻诱导期血流动力学的稳定,且不增加胃液残留量及反流误吸风险。 Objective：To observe the effect of oral liquid carbohydrates （1,000 mL of liquid carbohydrates 12h before operation, and 500 mL of liquid carbohydrates 2h before operation） based on enhanced recovery after surgery （ERAS） on gastric contents reflux aspiration and hemodynamics during general anesthesia induction in patients undergoing gastric cancer surgery.Methods：60 patients with ASA grade Ⅰ to Ⅱ and 35-70 years old who underwent laparoscopic radical gastrectomy were randomly divided into two groups： routine fasting group （group G）, and preoperative oral liquid carbohydrate group （group E）, with 30 cases in each group.Patients in group E took 1 000 mL of liquid carbohydrates 12 h before operation, and 500 mL of liquid carbohydrates 2 h before operation.Both groups of patients were given propofol combined with remifentanil target controlled intravenous and injection of cisatracurium in anesthesia induction.HR, BIS, MAP, CO, CI, and SVV were recorded before induction （T0）, just before intubation （T1）, 1 min （T2）, 3 min （T3）, 5 min （T4）, 10 min （T5）, and 20 min （T6） after induction.Gastric contents reflux aspiration during general anesthesia induction and gastric residual liquid capacity were also observed.Results：HR, BIS, MAP, CO, CI of both groups at T1 were significantly lower than those at T0 （P〈0.05）.SVV of group E at T2-T6 were lower than those of group G （P〈0.05）, and MAP, CO, and CI of group E at T1-T6 were higher than those of group G （P〈0.05）.There was no regurgitation aspiration in both groups during anesthesia induction.There was no significant difference between the two groups in gastric residual liquid capacity.Conclusions：Preoperative oral rehydration （1 000 mL of liquid carbohydrates 12 h before operation, and 500 mL of liquid carbohydrates 2 h before operation） based on ERAS can better maintain hemodynamic stability during induction of general anesthesia in patients undergoing elective gastric cancer surgery, without inc

关 键 词： 加速康复外科 术前口服液体 胃癌 血流动力学 每搏量变异度