LIU Rui,TIAN Mei-mei,YIN Xiao-bing,et al.Preoperative fasting time for patients undergoing hip and knee joint arthroplasty based on fast track surgery and multi-disciplinary treatment[J].同济大学学报（医学版）,2017,38(3):98-102, 107. [点击复制]
目的 探讨基于快速康复外科理念的多学科协作模式对缩短髋膝关节置换术患者术前禁食时间的应用效果。方法 将2016年1月至2016年10月行髋膝关节置换手术的患者按照多学科介入时间点的前后划分为传统组和多学科组。传统组183例患者采取传统禁食方案,多学科组125例患者采用个性化禁食方案,即通过评估患者和估算手术时间,制定手术前至少2h口服10%葡萄糖溶液、手术前至少6h进食清淡饮食的个性化饮食方案。比较两组患者在术前实际禁食、禁饮时间,术前饥饿口渴发生率,术后24h恶心呕吐发生率的差异。结果 术前,传统组实际禁食时间长于多学科组[(16.9±2.7)h vs (9.4±2.5)h,t=24.66,P＜0.001]；中重度饥饿发生率高于多学科组(51.9% vs 24%,χ2=23.99,P＜0.001)；中重度口渴发生率高于多学科组(74.8% vs 8.8%,χ2=129.8,P＜0.001)。术后,传统组24h恶心呕吐发生率高于多学科组(48.1% vs 31.2%,χ2=8.741,P＜0.05)。结论 基于快速康复理念的多学科协作模式的实施可有效缩短术前禁食禁饮时间,降低术前饥饿、口渴,术后恶心呕吐的发生率,且不增加误吸的发生。
Objective To assess the preoperative fasting time in patients undergoing hip and knee arthroplasty based on fast track surgery with muti-discinplinary collaboration care model. Methods Three hundred and eight patients undergoing hip and knee arthroplasty from January 2016 to October 2016 were enrolled in the study. Among them, 183 patients (control group) received conventional fating protocol; and 125 patients (study group) received the personalized fasting protocol based on muti-disciplinary collaboration care model, which includes taking orally dextrose solution or/and light meal at least 2 h or/and 6 h before elective procedures according to individual assessment. The actual fasting time, occurrence of preoperative hunger and thirsty of moderate/severe degree, postoperative nausea and vomiting were compared between the two groups. Results The actual fasting time in control and study groups was (16.9±2.7) and (9.4±2.5) h, respectively (t= 24.66,P＜0.001).The occurrence of preoperative rate of hunger and thirsty with moderate/severe degree and the occurrence rate of postoperative nausea and vomiting in study group were lower than those in control group (24% vs 51.9%, χ2=23.99,P＜0.001; 48.1% vs 31.2%, χ2=8.741, P＜0.05, respectively). Conclusion The personalized fasting protocol based on muti-disciplinary collaboration care model can decrease the preoperative fating time, as well as reduce the occurrence of preoperative hunger and thirsty and postoperative nausea and vomiting.
