Clinical Study Of Patients With Laparoscopic Hysterectomy Take Oral 10% Glucose Solution 2 Hours Before Operation Guided By Gastric Ultrasound

Objective:Gastric ultrasound was used to verify the safety of laparoscopic hysterectomy patients taking 10%glucose solution 2h before surgery,and to further explore it,s impact on the perioperative period.Methods:After obtaining the consent of the Ethics Committee of the Affiliated Hospital of Yan’an University,we selected 100 patients with the first daily laparoscopic hysterectomy under general anesthesia in our hospital from January 2019 to December2019,ASAⅠ^Ⅱ,aged 18⁶5 years old,according to the random number table,100subjects who meet the standard were randomly divided into two groups,namely oral sugar water group（group K）and regular drinking group（group C）,each group 50 cases.C group:fasting began at 22:00 on the night before operation,prohibition began at 24:00,K group:fasting began at 22:00 on the night before operation,and 10%glucose solution was taken according to the amount of 4ml/kg at 2 hours before operation.Patients in both groups did not receive any fluid infusion before anesthesia induction.After entering the operating room,the patient’s gastric emptying state was first evaluated by anesthesiologist A who had been trained by professional gastric ultrasound and did not know about the grouping situation,the specific methods were as follows:the gastric antrum of patients were scanned by gastric ultrasound in supine position,semi-lying position（45 degrees elevation of the head of the bed）and right lying position,and the gastric volume was evaluated qualitatively,semi-quantitatively and quantitatively.Qualitative evaluation mainly refers to the evaluation of the properties（liquid and solid）of gastric contents;Semi-quantitative evaluation refers to the application of ultrasound to scan the gastric antrum containing clear fluid when the patient is in the supine position or right supine position,and then the gastric antrum is divided into three grades according to the scanning results;Quantitative evaluation refers to the evaluation of the capacity of gastric contents by measuring the maximum diameters D1 and D2 of the gastric antrum scanned in the semi-recumbent position（head of the bed raised 45 degrees）and in the right recumbent position along the head and tail direction and the anterior and posterior direction of the body,and then the cross-sectional area of gastric antrum（cross-sectional area,CSA）under two different positions was calculated by using the formula,and the semi-recumbent position was marked as CSA₁,and the right recumbent position was marked as CSA₂.Next,the calculated CSA₁ and CSA₂ are respectively substituted into the prediction formula of gastric volume under two different postures,and gastric volume（gastric volume,GV）and gastric volume per unit body weight（GV/weight,GV/W）under different postures are respectively calculated,the semi-recumbent position was marked as GV₁,GV₁/W,and the right recumbent position was marked as GV₂,GV₂/W,and the risk of reflux aspiration is evaluated according to GV/W.A collaborator C,who had no knowledge of the grouping and gastric emptying assessed by gastric ultrasound,scored the VAS of thirst,hunger and anxiety at 2 hours before operation and before anesthesia induction.The mean arterial pressure（MAP）and heart rate（HR）at five different time points（T1:5min after admission,T2:the beginning of anesthesia induction,T3:5min after anesthesia induction,T4:the beginning of surgery,T5:the end of surgery）,as well as the first postoperative exhaust and defecation time,postoperative hospital stay,and the incidence of nausea and vomiting within 24 hours after surgery were recorded and compared between the two group.Results:1.There was no significant difference in CSA,GV,GV/W between the two groups,whether in the semi-recumbent position or the right-lying position（P>0.05）.compared with CSA under different postures in the two groups,CSA₂ is larger than CSA₁,and the difference is statistically significant（P<0.05）.2.There was no significant difference in VAS scores of thirst,hunger,and anxiety between the two groups 2h before surgery（P>0.05）;before anesthesia induction,the VAS scores of thirst,hunger and anxiety in the oral sugar water group were lower than those in the routine abstinence group,and there were significant differences.（P<0.01）.3.There was no significant difference in MAP and HR at five different times between the oral sugar water group and the conventional fasting group（P>0.05）;the MAP and HR of the two groups of patients changed with time,and the difference was statistically significant（P<0.05）.4.The first postoperative exhaust time in the oral sugar water group was earlier than that in the conventional drinking ban group,and the difference was statistically significant（P<0.05）.there was no statistically significant difference in the first postoperative defecation time and hospitalization time between the two groups（P>0.05）.5.The incidence of nausea and vomiting within 24 hours after operation in the oral sugar water group was lower than that in the conventional drinking fasting group,and the difference was statistically significant（P>0.05）.Conclusion:1.It is safe and feasible to take 10%glucose solution orally at a dose of4 ml/kg for patients with laparoscopic hysterectomy 2 hours before surgery,which does not increase the risk of perioperative regurgitation by increasing the gastric volume before anesthesia induction.2.Oral administration of 10%glucose solution at a dose of 4ml/kg for patients with laparoscopic hysterectomy 2 hours before surgery can relieve thirst,hunger and anxiety before anesthesia,thus improving the comfort level of patients before surgery.3.Oral administration of 10%glucose solution at a dose of 4ml/kg for patients with laparoscopic hysterectomy 2 hours before surgery can shorten the first postoperative exhaust time,promote promote the early recovery of gastrointestinal function after operation,and reduce the incidence of nausea and vomiting within 24 h after operation,thus accelerating the postoperative recovery process of patients.