术前口服补液溶液对乳腺癌根治术患者术后康复进程及预后的影响

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摘要目的研究乳腺癌根治术患者术前口服补液盐（ORS）补液对术后康复进程及预后的影响。方法选取2017年10月~2018年3月河北北方学院附属第一医院择期实施乳腺癌根治手术患者80例，根据随机数字表法将其分为观察组和对照组，每组各40例。两组均实施相同麻醉及手术方案，对照组术前8 h禁食、4 h禁水，术中正常补液；观察组术前2 h口服ORS 300 mL，术中根据患者情况调整补液量。监测患者入室静息状态下（T0）、插管即刻（T1）、手术开始后10 min（T2）、手术结束即刻（T3）、术后1 d（T4）的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）变化情况；观察术前1 d（术前）及术后1 d（术后）空腹血糖（FPG）、空腹胰岛素（FINS）、C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）水平；统计麻醉时间、术中输液量、麻醉苏醒时间、肛门首次排气时间、首次进食时间、下床时间及不良反应发生率；记录术后1年生存情况。结果组间比较、时间点比较及交互作用比较，差异均有统计学意义（均P < 0.05）；两组T1、T2时间点HR、MAP均高于本组T0，差异均有统计学意义（均P < 0.05）；观察组T1、T2、T3时间点HR、MAP均低于对照组，差异均有统计学意义（均P < 0.05）。两组术前FPG、FINS、CRP、TNF-α比较，差异均无统计学意义（均P ＞ 0.05）；术后FPG、FINS、CRP、TNF-α显著高于术前，且观察组低于对照组，差异均有统计学意义（均P ＜ 0.05）。两组术后麻醉时间、麻醉苏醒时间、下床时间比较，差异均无统计学意义（均P ＞ 0.05）；观察组术中输液量少于对照组，肛门首次排气时间、首次进食时间短于对照组，差异均有统计学意义（均P ＜ 0.05）。观察组总不良反应发生率低于对照组，差异有统计学意义（P ＜ 0.05）。两组术后1年生存率均为100%。结论乳腺癌根治术患者术前口服ORS补液可在一定程度上维持术中血压及HR平稳，改善患者术后恢复及不良反应发生情况，且对1年内生存情况影响较小。

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	訾聪娜1 樊娟1 李艳明2 李福龙1 马先3 邢珍1

关键词 ：乳腺癌, 乳腺癌根治术, 口服补液盐, 加速康复外科

Abstract：Objective To study the effect of preoperative oral rehydration salt (ORS) on postoperative rehabilitation process and prognosis in patients undergoing radical mastectomy. Methods From October 2017 to March 2018, 80 cases undergoing elective radical mastectomy in the First Affiliated Hospital of Hebei North University were selected. According to the random number table method, they were divided into observation group and control group, with 40 cases in each group. Both groups were given the same anesthesia and surgical plan. Control group was treated with fasting at 8 h on preoperative and water-deprivation at 4 h on preoperative, fluid infusion during surgery. Observation group was given oral ORS solution 300 mL at 2 h on preoperative. The fluid infusion volume was adjusted according to the patient′s condition. The changes in heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2) were monitored at entering room and rest state (T0), at immediate intubation time (T1), at 10 min after start of surgery (T2), at end of surgery immediately (T3) and 1 d after surgery (T4). The levels of fasting plasma glucose (FPG), fasting insulin (FINS), C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) at 1 d before surgery (preoperative) and 1 d after surgery (postoperative) were observed. The anesthesia time, intraoperative transfusion volume, anesthesia recovery time, the first anal exhaust time, the first eating time, leaving bed time and incidence of adverse reactions were statistically analyzed. The survival at 1 year on postoperative was recorded. Results Comparison between groups, comparison between time points and the interaction comparison showed statistically significant differences (all P < 0.05). HR, MAP at time points T1, T2 were higher than T0 in same group of two groups, and the differences were statistically significant (all P < 0.05). HR, MAP at time points T1, T2, T3 in observation group were all lower than those in control group, and the differences were statistically significant (all P < 0.05). There were no statistically significant differences in FPG, FINS, CRP and TNF-α between two groups on preoperative (all P > 0.05). FPG, FINS, CRP and TNF-α on postoperative were significantly higher than those on preoperative, and observation group was lower than control group, and the differences were statistically significant (P < 0.05). There were no significant differences between two groups in anaesthesia time, anaesthesia recovery time and leaving bed time on postoperative (all P > 0.05). Intraoperative infusion volume was less than that of control group, the first anal exhaust time and the first eating time in observation group were shorter than those in control group, and the differences were statistically significant (all P < 0.05). The incidence of total adverse reactions in observation group was lower than that in control group, and the difference was statistically significant (P < 0.05). At 1 year on postoperative, survival rates of two groups were both 100%. Conclusion Oral ORS for patients before radical mastectomy can maintain stability of intraoperative blood pressure and HR to a certain extent, improve postoperative recovery and occurrence of adverse reactions, with few effects on survival within 1 year.

Key words： Breast cancer Radical mastectomy Oral rehydration salt Enhanced recovery after surgery

基金资助:河北省医学科学研究课题计划（20190889）。

通讯作者: 邢珍（1968.11-），女，硕士，主任医师，硕士生导师；研究方向：心脏手术麻醉。

作者简介: 訾聪娜（1980.12-），女，硕士；研究方向：老年患者手术麻醉。

引用本文:

訾聪娜1 樊娟1 李艳明2 李福龙1 马先3 邢珍1. 术前口服补液溶液对乳腺癌根治术患者术后康复进程及预后的影响[J]. 中国医药导报, 2019, 16(34): 112-116.
ZI Congna1 FAN Juan1 LI Yanming2 LI Fulong1 MA Xian3 XING Zhen1. Effect of preoperative oral rehydration salt on postoperative rehabilitation process and prognosis in patients undergoing radical mastectomy. 中国医药导报, 2019, 16(34): 112-116.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2019/V16/I34/112

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