假饲联合早期流质饮食对腹腔镜肝切除术后患者胃肠功能恢复的影响

朱春芳; 郑露珊; 俞世安

doi:10.16766/j.cnki.issn.1674-4152.002232

假饲联合早期流质饮食对腹腔镜肝切除术后患者胃肠功能恢复的影响

doi: 10.16766/j.cnki.issn.1674-4152.002232

金华市中心医院普外科，浙江金华 321000

基金项目:

浙江省基础公益研究计划项目 LGF20H160028

详细信息

通讯作者:
郑露珊, E-mail: zhlushan52@163.com

中图分类号: R657.3 R459.3
计量
- 文章访问数: 246
- HTML全文浏览量: 131
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2020-04-27

The effect of sham feeding combined with early fluid diet on the recovery of gastrointestinal function after laparoscopic hepatectomy

Department of General Surgery, Jinhua Central Hospital, Jinhua, Zhejiang 321000, China

摘要

摘要: 目的探究假饲(咀嚼口香糖)联合早期流质饮食对腹腔镜肝切除术后患者胃肠功能的影响。方法选取2018年6月—2019年12月在金华市中心医院普外科接受腹腔镜肝切除手术的患者112例，按随机数字表法分为咀嚼组(36例)、对照组(38例)和空白组(38例)。咀嚼组：麻醉清醒后予以咀嚼口香糖(1次/2 h，每次2~3片，术后6 h流质饮食，3~5次/d)；对照组：术后6 h予以流质饮食，3~5次/d；空白组：术后6 h进饮温开水，肛门排气后，给予流质食物。比较3组患者肠鸣音恢复、首次肛门排气、排便时间、血清胃动素、胃泌素水平及术后胃肠道症状。结果咀嚼组肠鸣音恢复、首次排气、排便时间[(9.76±1.59)h、(20.57±2.31)h、(56.82±8.27)h]均早于对照组[(11.08±1.96)h、(26.64±2.77)h、(64.33±10.39)h]及空白组[(15.26±2.09)h、(30.05±3.85)h、(72.94±11.67)h]，差异均有统计学意义(t=3.171、10.207、3.428；12.688、12.756、6.822，均P＜0.05);术后第1天咀嚼组患者胃动素和胃泌素水平均高于对照组和空白组(均P＜0.05);咀嚼组患者术后恶心和呕吐发生率低于对照组和空白组(均P＜0.05)。结论假饲联合早期流质饮食能够加快腹腔镜肝切除术患者胃肠功能的恢复。
- 腹腔镜肝切除术 /
- 咀嚼口香糖 /
- 早期流质饮食 /
- 胃肠功能恢复
Abstract: Objective To explore the effect of sham feeding (chewing gum) combined with early liquid diet on the recovery of gastrointestinal function in patients with laparoscopic hepatectomy. Methods A total of 112 patients who underwent laparoscopic hepatectomy in the Department of General Surgery of Jinhua Central Hospital from June 2018 to December 2019 were selected as the study subjects. They were randomly divided into chewing group (36 cases), control group (38 cases) and blank group (38 cases). Chewing group: chewing gum (1 time/2 h, 2 ~ 3 tablets each time) combined with early liquid diet (6 hours after operation, 3 ~ 5 times/day). Control group: liquid diet was given 6 hours after operation, 3 ~ 5 times/day. Blank group: drink warm boiled water 6 hours after operation, and give liquid food after anal exhaust. The recovery of bowel sounds, first anal exhaust, defecation time, serum motilin MTL, gastrin gas levels and postoperative gastrointestinal symptoms were compared among the three groups. Results The recovery of bowel sounds, first exhaust and defecation time in the chewing group [(9.76±1.59) h, (20.57±2.31) and (56.82±8.27) h] were significantly earlier than those in the control group [(11.08±1.96) h, (26.64±2.77) h, and (64.33±10.39) h], the blank group [(15.26±2.09) h, (30.05±3.85) h, and (72.94±11.67) h]. The differences were statistically significant (t=3.171, 10.207, 3.428; 12.688, 12.756, 6.822, all P < 0.05). On the first day after operation, the levels of motilin MTL and gastrin gas in chewing group were higher than those in control group and blank group (all P < 0.05). The incidence of postoperative nausea and vomiting in chewing group was lower than that in control group and blank group (all P < 0.05). Conclusion Sham feeding combined with early liquid diet can effectively promote the recovery of gastrointestinal function after laparoscopic hepatectomy.
- Laparoscopic hepatectomy /
- Chewing gum /
- Early fluid diet /
- Gastrointestinal function recovery
利益冲突 无

HTML全文

表 1 3组腹腔镜肝切除术患者胃肠功能恢复情况比较(x±s, h)

组别	例数	肠鸣音恢复时间	首次肛门排气时间	首次排便时间
咀嚼组	36	9.76±1.59^ab	20.57±2.31^ab	56.82±8.27^ab
对照组	38	11.08±1.96^a	26.64±2.77^a	64.33±10.39^a
空白组	38	15.26±2.09	30.05±3.85	72.94±11.67
F值		85.595	90.789	22.982
P值		＜0.001	＜0.001	＜0.001
注：与空白组比较，^aP＜0.05；与对照组比较，^bP＜0.05。

下载: 导出CSV

表 2 3组腹腔镜肝切除术患者MTL、GAS比较(x±s, ng/L)

组别	例数	MTL		GAS
组别	例数	术前1 d	术后第1天	术前1 d	术后第1天
咀嚼组	36	271.50±24.61	259.72±30.47^ab	72.64±22.85	62.43±14.18^ab
对照组	38	270.49±26.08	205.88±32.15^ac	73.09±23.11	50.18±21.68^c
空白组	38	273.03±25.70	174.53±28.92^c	71.92±21.43	44.74±18.51^c
F值		0.096	73.279	0.026	8.868
P值		0.908	＜0.001	0.974	＜0.001
注：与空白组比较，^aP＜0.05；与对照组比较，^bP＜0.05；与术前比较，^cP＜0.05。

下载: 导出CSV

表 3 3组腹腔镜肝切除术患者术后并发症发生情况比较[例(%)]

组别	例数	恶心	呕吐	腹胀
咀嚼组	36	5(13.89)^ab	2(5.56)^ab	5(13.89)
对照组	38	11(28.95)	7(18.42)	7(18.42)
空白组	38	15(39.47)	11(28.95)	10(26.31)
χ²值		6.091	6.909	1.863
P值		0.043	0.031	0.215
注：与空白组比较，^aP＜0.05；与对照组比较，^bP＜0.05。

下载: 导出CSV

参考文献(22)

[1]	蔡秀军, 蔡柳新. 腹腔镜肝切除术关键技术、难点及对策[J]. 中国实用外科杂志, 2017, 37(5): 461-465. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201705001.htm
[2]	何国林, 洪合, 程远, 等. 快速康复外科理念在腹腔镜肝切除术中的应用[J]. 中华普通外科杂志, 2018, 33(8): 635-637. doi: 10.3760/cma.j.issn.1007-631X.2018.08.004
[3]	韩冰, 丁义涛, 朱新华, 等. 加速康复外科理念在腹腔镜肝切除术中的应用[J]. 临床肝胆病杂志, 2018, 34(3): 567-569. doi: 10.3969/j.issn.1001-5256.2018.03.024
[4]	潘雨萍, 冯素文. 假饲联合早进食半流质饮食对改善妇科腹腔镜术后患者营养状况的影响[J]. 护理与康复, 2016, 15(3): 203-205. doi: 10.3969/j.issn.1671-9875.2016.03.001
[5]	杜海虹, 毛熙光. 咀嚼口香糖对腹部手术胃肠功能影响的研究进展[J]. 西南军医, 2016, 17(2): 172-175. doi: 10.3969/j.issn.1672-7193.2016.02.026
[6]	王梅, 陈永惠, 朱文俊. 嚼口香糖联合穴位按摩对腹部术后胃肠功能恢复的影响[J]. 安徽卫生职业技术学院学报, 2020, 19(5): 143-145. https://www.cnki.com.cn/Article/CJFDTOTAL-AHWZ202005068.htm
[7]	徐娜. 饮食营养管理对结直肠癌术后免疫功能及营养状况的影响[J]. 山西医药杂志, 2020, 49(1): 109-111. doi: 10.3969/j.issn.0253-9926.2020.01.046
[8]	屈文慧, 陈立阳, 罗成江. 腹腔镜胆囊切除手术后恶心呕吐的分级防治[J]. 宁夏医学杂志, 2016, 38(1): 69-71. https://www.cnki.com.cn/Article/CJFDTOTAL-NXYX201601033.htm
[9]	陈凛, 陈亚进, 董海龙, 等. 加速康复外科中国专家共识及路径管理指南(2018版)[J]. 中国实用外科杂志, 2018, 38(1): 1-20. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201801001.htm
[10]	LIU Q, JIANG H, XU D, et al. Effect of gum chewing on ameliorating ileus following colorectal surgery: A meta-analysis of 18 randomized controlled trials[J]. Int J Surg, 2017, 47(8): 107-115. http://www.sciencedirect.com/science/article/pii/S1743919117306659
[11]	GE B, ZHAO H, LIN R, et al. Influence of gum-chewing on postoperative bowel activity after laparoscopic surgery for gastric cancer[J]. Medicine, 2017, 96(13): e6501. doi: 10.1097/MD.0000000000006501
[12]	张一清, 马晨阳. 早期咀嚼木糖醇口香糖对腹腔镜胃癌术后患者肠蠕动恢复的影响[J]. 中国乡村医药, 2018, 25(9): 6-7. doi: 10.3969/j.issn.1006-5180.2018.09.003
[13]	白润芳, 杨晓梅, 张帅, 等. 咀嚼口香糖促进腹腔镜术后肛门排气排便[J]. 局解手术学杂志, 2017, 26(8): 585-588. https://www.cnki.com.cn/Article/CJFDTOTAL-JJXZ201708010.htm
[14]	杜章, 李丽军, 严景凤. 咀嚼口香糖对结直肠手术后胃肠道功能恢复的影响[J]. 中国实用医刊, 2018, 45(11): 91-93. doi: 10.3760/cma.j.issn.1674-4756.2018.11.030
[15]	周欢, 吕桂芬. 咀嚼运动促进腹腔镜结直肠癌术后肠功能恢复的研究[J]. 护士进修杂志, 2017, 32(22): 67-68. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX201722026.htm
[16]	MANAL H M, SAFAA H. Chewing gum for declining ileus and accelerating gastrointestinal recovery after appendectomy[J]. Front Nurs, 2018, 5(4): 277-284. doi: 10.1515/fon-2018-0038
[17]	王刚, 韩俊岭, 王放, 等. 胃肠道动力障碍的相关因子在家兔重症急性胰腺炎模型的变化[J]. 河北医学, 2019, 25(2): 229-233. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX201902015.htm
[18]	许亚莉. 咀嚼口香糖联合早期半流质饮食在腹腔镜胆囊切除术后胃肠功能恢复中的应用[D]. 苏州: 苏州大学, 2018.
[19]	FANG J, WANG S L, FU H Y, et al. Impact of gum chewing on the quality of bowel preparation for colonoscopy: An endoscopist-blinded, randomized controlledtrial[J]. Gastrointest Endosc, 2016, 17(16): 30258-30259.
[20]	王瑞莲, 杨昕丽, 阮艳超, 等. 咀嚼口香糖对妇科腹腔镜术后恶心呕吐的影响[J]. 山西医药杂志, 2018, 47(11): 1288-1290. doi: 10.3969/j.issn.0253-9926.2018.11.022
[21]	孙妍, 梁丽芹, 刘敏, 等. 咀嚼口香糖对结直肠癌患者根治术后肠功能影响的循证实践[J]. 中华现代护理杂志, 2017, 23(23): 2972-2976. doi: 10.3760/cma.j.issn.1674-2907.2017.23.007
[22]	张媛媛, 陆绚, 钮美娥, 等. 咀嚼口香糖对结肠镜检查患者服药依从性及不良反应的影响[J]. 护理学杂志, 2017, 32(9): 34-36. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ201709012.htm