缩短禁饮时间对无痛胃肠镜检查患者围手术期恢复质量及安全性的影响

Influence of shortened preoperative fluid fasting on perioperative recovery quality and safety in patients undergoing gastrointestinal endoscopy under anesthesia

摘要:

目的 比较3种禁饮方案对接受无痛胃肠镜检查患者围手术期恢复质量的影响并评估安全性。方法 选择扬州大学附属医院2023年10月至2024年1月无痛胃肠镜检查患者90例，按照随机区组设计分配不同的禁饮时间，每组30例。C组检查前按常规方案，即禁饮4 h以上；O1组检查前1 h时饮水200 mL后严格禁饮；O2组检查前2 h时饮水200 mL后严格禁饮。检查前超声评估胃容量，胃镜进镜后抽吸胃内残余液量。记录血压、心率。结束后采用15项恢复质量评分量表（quality of requirements‑15，QoR‑15）评估康复质量，Christensen疲劳评分量表评估疲劳程度。围手术期监测血糖，采用视觉模拟评分法（visual analogue scale，VAS）评估口渴、饥饿、满意度评分，并记录不良反应，排气、排便时间。结果 C组、O1组、O2组检查前胃容量［（17.31±14.00）ml比（17.49±11.59）ml比（21.91±16.13）ml，F=1.000，P=0.372］与胃内残余液量［（8.23±6.18）mL比（11.80±8.50）mL比（9.57±7.39）mL，F=1.711，P=0.187］，差异无统计学意义。O1与O2组麻醉后（T2~T6）血压较C组高［T2：（82.60±9.41）mmHg比（81.80±8.68）mmHg比（76.87±8.84）mmHg，F=3.464，P=0.036；T3：（80.47±7.03）mmHg比（79.03±7.88）mmHg比（74.73±8.16）mmHg，F=4.353，P=0.016；T4：（75.00±8.37）mmHg比（74.53±7.25）mmHg比（69.70±9.59）mmHg，F=3.495，P=0.035；T5：（76.47±11.06）mmHg比（75.50±7.63）mmHg比（68.80±9.75）mmHg，F=5.505，P=0.006；T6：（78.37±9.83）mmHg比（77.23±7.02）mmHg比（72.57±9.45）mmHg，F=3.494，P=0.035］，心率较C组低［T2：（77.97±10.70）bpm比（81.67±7.34）bpm比（88.53±9.65）bpm，F=9.560，P<0.001；T3：（74.93±8.99）bpm比（78.50±7.77）bpm比（90.27±8.11）bpm，F=27.062，P<0.001；T4：（74.43±9.19）bpm比（77.87±6.78）bpm比（89.33±11.08）bpm，F=20.931，P<0.001；T5：（73.03±8.24）bpm比（76.70±7.10）bpm比（87.53±9.82）bpm，F=23.027，P<0.001；T6：（76.90±6.45）bpm比（78.47±5.73）bpm比（86.23±7.23）bpm，F=17.169，P<0.001］，O1与O2组检查结束时血糖值［（5.88±0.92）mmol/L比（6.06±0.86）mmol/L比（6.56±1.03）mmol/L，F=4.114，P=0.020］，Christensen评分［（2.73±1.18）分比（3.20±1.38）分比（4.03±1.64）分，F=6.302，P=0.003］低于C组，QoR‑15评分高于C组［（135.40±4.81）分比（132.87±7.82）分比（129.03±7.59）分，F=6.304，P=0.003］，排气时间［（20.43±7.48）h比（22.27±5.36）h比（26.13±6.70）h，F=5.689，P=0.005］、排便时间［（37.37±13.96）h比（39.93±8.96）h比（46.23±12.06）h，F=4.308，P=0.016］早于C组，而O1、O2组间差异无统计学意义（P>0.05）。与O2组、C组相比，O1组口渴、饥饿评分较低，满意度评分较高（P<0.05），3组间不良反应发生率差异无统计学意义（P>0.05）。结论 胃肠镜检查前缩短禁饮时间可以缓解血糖升高，改善循环和恢复质量。此外，缩短禁饮时间至1 h可以带来明显的舒适体验，提高满意度，且不引起胃内液体和不良反应的增加，安全性好。

Abstract:

Objective To compare the effects of three oral fluid fasting regimens on perioperative recovery quality and safety in patients undergoing gastroenteroscopy under anesthesia. Methods Ninety patients scheduled for gastroenteroscopy under anesthesia in Affiliated Hospital of Yangzhou University from October 2023 to January 2024 were randomly assigned to different fluid fasting duration according to a randomized block design: Group C underwent routine fasting (>4 hours); Group O1 received 200 mL of water 1 hour before the procedure, followed by strict fasting; Group O2 received 200 mL of water 2 hours before the procedure, followed by strict fasting. The gastric volume was evaluated by ultrasound before examination, and the residual fluid in the stomach was suctioned during gastroscopy. Blood pressure and heart rate were monitored. Recovery quality was assessed by quality of requirements-15 (QoR-15 scale) and fatigue by Christensen scale. Perioperative blood glucose was monitored and visual analogue scale (VAS) scores of hunger, thirst, satisfaction were evaluated. Adverse reactions and time of first flatus and defecation were recorded. Results There was no significant difference in gastric volume (17.31±14.00 mL VS 17.49±11.59 mL VS 21.91±16.13 mL, F=1.000, P=0.372) or residual fluid volume (8.23±6.18 mL VS 11.80±8.50 mL VS 9.57±7.39 mL, F=1.711, P=0.187) among the three groups. The blood pressure of group O1 and O2 after anesthesia (T2-T6) was higher than that of group C (T2: 82.60±9.41 mmHg VS 81.80±8.68 mmHg VS 76.87±8.84 mmHg, F=3.464, P=0.036; T3: 80.47±7.03 mmHg VS 79.03±7.88 mmHg VS 74.73±8.16 mmHg, F=4.353, P=0.016; T4: 75.00±8.37 mmHg VS 74.53±7.25 mmHg VS 69.70±9.59 mmHg, F=3.495, P=0.035; T5: 76.47±11.06 mmHg VS 75.50±7.63 mmHg VS 68.80±9.75 mmHg, F=5.505, P=0.006; T6: 78.37±9.83 mmHg VS 77.23±7.02 mmHg VS 72.57±9.45 mmHg, F=3.494, P=0.035), and heart rate was lower than that of group C (T2: 77.97±10.70 bpm VS 81.67±7.34 bpm VS 88.53±9.65 bpm, F=9.560, P<0.001; T3: 74.93±8.99 bpm VS 78.50±7.77 bpm VS 90.27±8.11 bpm, F=27.062, P<0.001; T4: 74.43±9.19 bpm VS 77.87±6.78 bpm VS 89.33±11.08 bpm, F=20.931, P<0.001; T5: 73.03±8.24 bpm VS 76.70±7.10 bpm VS 87.53±9.82 bpm, F=23.027, P<0.001; T6: 76.90±6.45 bpm VS 78.47±5.73 bpm VS 86.23±7.23 bpm, F=17.169, P<0.001). The blood glucose value at the end of examination (5.88±0.92 mmol/L VS 6.06±0.86 mmol/L VS 6.56±1.03 mmol/L,F=4.114,P=0.020),Christensen score (2.73±1.18 scores VS 3.20±1.38 scores VS 4.03±1.64 scores, F=6.302, P=0.003) of group O1 and O2 were lower than those of group C, the QoR-15 recovery score was higher than that of group C (135.40±4.81 scores VS 132.87±7.82 scores VS 129.03±7.59 scores, F=6.304, P=0.003). The first flatus (20.43±7.48 h VS 22.27±5.36 h VS 26.13±6.70 h, F=5.689, P=0.005) and defecation time (37.37±13.96 h VS 39.93±8.96 h VS 46.23±12.06 h, F=4.308, P=0.016) were earlier than those of group C, but there was no significant difference between the O1 and O2 groups (P>0.05). Compared with group O2 and group C, group O1 had lower thirst and hunger scores and higher satisfaction scores (P<0.05). Among three groups, there was no significant difference in incidence of adverse reactions (P>0.05). Conclusion Shortened preoperative fluid fasting before gastroenteroscopy attenuates blood glucose elevation, improves circulation, and enhances recovery quality. A 1-hour fasting regimen additionally improves patient comfort and satisfaction without increasing gastric fluid volume or adverse events, which is safe.