小儿眼科日间手术术前2h口服多维饮料的应用观察

目的探讨眼科全麻患儿术前2 h口服多维饮料(术能)对术中排空及术后并发症的影响。方法选取需实行日间眼科手术的患儿120例,采用随机数字表法分为禁饮组、葡萄糖组和多维饮料组,每组40例。术前12 h禁食,禁饮组麻醉前6 h禁饮,葡萄糖组麻醉前2 h口服10%葡萄糖溶液,多维饮料组麻醉前2 h口服多维饮料(术能),饮用量均为5 m L/kg。麻醉前2 h、服用清饮前B超测定胃内残留量;麻醉前即刻进行面罩接受程度评分;测定麻醉后手术前即刻患儿Ramsay镇静、CHEOPS疼痛评分;检测麻醉前、术毕及术后3 h血糖及胰岛素含量以及观察术后并发症发生情况。结果 3组患儿镇静评分比较差异无统计学意义(P> 0. 05),多维饮料组面罩接受程度显著高于其余2组,多维饮料组麻醉后疼痛评分显著低于其余2组,上述差异均有统计学意义(均P <0. 05)。3组患儿2个时间点胃内残留量比较差异无统计学意义(P> 0. 05),多维饮料组术后肛门排气时间和恶心、呕吐程度优于葡萄糖组和禁饮组(均P <0. 05);血糖及胰岛素水平比较,麻醉前多维饮料组和葡萄糖组均显著高于禁饮组,而术后即刻禁饮组血糖和胰岛素水平均高于另外2组,差异均有统计学意义(均P <0. 05),3组术后3 h血糖、胰岛素水平差异无统计学意义(均P> 0. 05)。结论择期全麻手术患儿,麻醉诱导前2 h口服多维饮料,其并不增加患者术中反流、误吸的风险,还能有效缓解患者术后胰岛素抵抗的发生,值得临床推广。

Effect of preoperative oral multivitamin beverage on day surgery for children in ophthalmic department

Objective To study the effect of oral multivitamin beverage 2 hours before the anesthesia induction on gastric emptying and postoperative complications in children undergoing ophthalmic day surgery. Methods Total 120 children undergoing the day operation were selected and divided into the liquid fasting group, the glucose group and the multivitamin group (n=40) according to random number table. All patients in the three groups fasted 12 hours before the surgery. The patients in the liquid fasting group did not drink 6 before the anesthesia, The patients in the glucose group was given 10% glucose solution 2 hours before anesthesia, and the patients in the multivitamin group took take orally multivitamin beverage 2 hours before the anesthesia, the volume of liquid was 5 m L/kg bodyweight. The amount of gastric remnants was measured by B ultrasound before taking orally liquid (2 h before operation). Mask acceptability score was carried out immediately before the anesthesia. Ramsay sedation score and CHEOPS pain score were performed between the anesthesia and operation. The levels of blood glucose and insulin were tested before the anesthesia, immediately after the operation and 3 h after the operation. The complications was recorded. Results There were no statistical difference in the sedation score among the three groups (P > 0.05). The mask acceptability score of the multivitamin group was significantly higher than those of the other two groups (all P < 0.05). The CHEOPS pain score of the multivitamin group was significantly lower than those of the other two groups (all P < 0.05). There were no statistical difference in the amount of gastric remnants among the three groups (P > 0.05). In the multivitamin group, the time of restoration of anal exhaust was shorter, and the incidence of nausea and vomiting was lower, as compared with the other two groups. Blood glucose and insulin levels in the glucose group and multivitamin group was significantly higher than that in the liquid fasting group, however, these levels immediately after the operation in the liquid fasting group exceeded the glucose group and multivitamin group, the difference was statistical significant (all P < 0.05). There was no statistically difference in the levels of blood glucose and insulin levels 3 h after the operation and the incidence of complications among the three groups (all P > 0.05). Conclusion For the children undergoing surgery under general anesthesia, oral multivitamin 200 m L at 2 h before anesthesia induction can effectively alleviate the preoperative thirst, anxiety and relieve postoperative nausea, vomiting and other complications, without increasing the risk of reflux and aspiration.