摘要目的 探讨骨科患者围术期阶梯性进食饮的临床应用价值。方法 选取2018年1月～2019年4月在我院就诊的200 例骨科围术期患者作为研究对象，根据禁食禁饮时间将其分为对照组和实验组，每组各100 例。对照组患者于术前12 h 禁食，术前4 h 禁饮，术后6 h 告知患者开始进食进饮，术后1 d 进食流质饮食。实验组患者于术前6 h 禁食，术前2 h 禁饮，麻醉清醒后进饮，分别于10、30 min 及1、2、3、4 h 根据患者需求阶梯性给予饮用水，5～15 ml/次，麻醉清醒4 h 后正常饮食。比较两组患者的不良反应发生情况、肛门排气时间、住院日、舒适度[采用视觉模拟量表（VAS）评价]、总满意度及不同时间点实验室指标[血红蛋白（HGB）、清蛋白（ALB）、前清蛋白（PA）及空腹血糖]变化情况。结果 实验组患者的饥饿、口渴、咽喉不适发生率（7.00%、9.00%、22.00）均低于对照组（17.00%、19.00%、36.00%），差异有统计学意义（P＜0.05）；实验组患者的恶心呕吐、腹泻、腹胀（5.00%、0.00%、2.00%）与对照组（3.00%、1.00%、4.00%）比较，差异无统计学意义（P＞0.05）。术前1 h，实验组患者的HGB、ALB、PA 及空腹血糖水平分别为（130.54±24.28）g/L、（39.23±5.31）g/L、（319.83±31.96）mg/L、（5.93±0.97）mmol/L，对照组患者的HGB、ALB、PA 及空腹血糖水平分别为（122.78±23.37）g/L、（35.14±5.18）g/L、（286.24±31.49）mg/L、（5.26±0.72）mmol/L；术后1 h，实验组患者的HGB、ALB、PA 及空腹血糖水平分别为 （132.18±27.56）g/L、（39.46±5.28）g/L、（319.56±31.85）mg/L、（5.89±0.92）mmol/L，对照组患者的HGB、ALB、PA 及空腹血糖水平分别为 （121.46±22.59）g/L、（35.08±5.19）g/L、（285.27±31.42）mg/L、（5.24±0.69）mmol/L；术前1 h、术后1 h，实验组患者的HGB、ALB、PA 及空腹血糖水平均高于对照组，差异有统计学意义（P＜0.05）。实验组患者的肛门排气时间[（9.14±1.89）h]及住院日[（11.26±1.53）d]均短于对照组[（15.92±2.68）h、（14.49±1.67）d]，VAS 评分[（2.53±0.82）分]低于对照组[（5.82±1.09）分]，差异有统计学意义（P＜0.05）。实验组患者的总满意度（97.00%）高于对照组（89.00%），差异有统计学意义（P＜0.05）。结论 骨科患者围术期阶梯性进食饮的临床应用价值较高，可有效降低患者饥饿、口渴、咽喉不适发生率，促进胃肠道功能恢复，缩短住院时间，提升患者舒适度及满意度。
Abstract：Objective To investigate the clinical application value of perioperative stepwise eating and drinking in orthopedic patients.Methods A total of 200 orthopedic perioperative patients who were admitted to our hospital from January 2018 to April 2019 were enrolled in the study.They were divided into control group and experimental group according to the time of fasting and banned drinking,with 100 cases in each group.In the control group,patients were fasted 12 h before surgery,banned drinking 4 h before surgery.Six hours after surgery,patients were encouraged to drink a small amount of water.One day after surgery,they were fed fluid diet.In the experimental group,patients were fasted 6 h before surgery,and banned drinking 2 h before surgery.After anesthesia awaking,patients were provided with water in stepwise according to their needs at 10,30 min and 1,2,3,4 h,5-15 ml each time.Four hours after anesthesia awaking,they were provided with normal diet.The incidence of adverse reactions,anal exhaust time,hospital stay,comfort (evaluated with visual analogue scale [VAS]),total satisfaction and changes in laboratory indicators(hemoglobin [HGB],albumin [ALB],prealbumin [PA]and fasting blood glucose) were compared between the two groups.Results The incidence rates of hunger,thirst and throat discomfort in the experimental group (7.00%,9.00%,22.00%) were lower than those in the control group accounting for 17.00%,19.00%,and 36.00%,respectively,with statistically significant differences (P＜0.05).There were no significant differences in the incidence rates of nausea and vomiting,diarrhea,and abdominal distension between the experimental group (5.00%,0.00%,2.00%) and the control group (3.00%,1.00%,4.00%) (P＞0.05).One hour before surgery,in the experimental group,the levels of HGB,ALB,PA and fasting blood glucose were (130.54±24.28) g/L,(39.23±5.31) g/L,(319.83±31.96) mg/L,(5.93±0.97) mmol/L,and in the control group,the levels of HGB,ALB,PA and fasting blood glucose were (122.78±23.37) g/L,(35.14±5.18) g/L,(286.24±31.49) mg/L,and (5.26±0.72) mmol/L,respectively.One hour after surgery,the levels of HGB,ALB,PA and fasting blood glucose in the experimental group were (132.18±27.56) g/L,(39.46±5.28) g/L,(319.56±31.85) mg/L,(5.89±0.92) mmol/L,and in the control group,the levels of HGB,ALB,PA,fasting blood glucose were (121.46±22.59) g/L,(35.08±5.19) g/L,(285.27±31.42) mg/L,(5.24±0.69) mmol/L,respectively.The levels of HGB,ALB,PA and fasting blood glucose in the experimental group 1 h before surgery and 1 h after surgery were all higher than those in the control group,with statistically significant differences (P＜0.05).The anal exhaust time ([9.14±1.89]h) and hospital stay ([11.26±1.53]d) of the experimental group were shorter than those of the control group ([15.92±2.68]h,(14.49±1.67]d),VAS score ([2.53±0.82]points) was lower than that of the control group ([5.82±1.09]points),and the differences were statistically significant (P＜0.05).The total satisfaction of the patients in the experimental group (97.00%) was higher than that in the control group (89.00%),and the difference was statistically significant (P＜0.05).Conclusion The clinical application value of perioperative stepwise eating and drinking in orthopedic patients is high,which can effectively reduce the incidence of hunger,thirst and throat discomfort,promote the recovery of gastrointestinal function,shorten the hospital stay,and improve comfort and satisfaction of patients.
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