| Objective:Observation of lumbar disc surgery in patients with preoperative oral carbohydrate 2h for postoperative insulin resistance,stress reaction,subjective comfort and complications,and postoperative nutritional management in the concept of ERAS of its nutrition status,stress reaction,subjective comfort,gastrointestinal adverse symptoms and postoperative anal exhaust time,etc.To explore the nutritional management scheme of patients with lumbar disc herniation under the concept of ERAS,in order to improve their nutritional status,reduce insulin resistance and stress response,and provide a practical basis for accelerating their recovery.Method: Part 1: Effects of preoperative oral carbohydrate intake on insulin resistance in patients undergoing lumbar disc herniationSelecting the second hospital of shanxi medical university orthopaedic spinal line of 96 hospitalized patients with lumbar disc surgery,were randomly divided into experimental group(48 cases)and control group(48 cases).the control group drank plain boiled water 2 hours before the operation,the experimental group drank carbohydrates 2 hours before the operation,and the others were performed according to hospital routine(without glucose and insulin).Peripheral venous blood of patients was extracted 3 hours before the operation,1 day after the operation on early morning and 3 day after the operation on early morning to detect and compare blood glucose and insulin,and the homeostasis model assessment(HOMA)was used to calculate the insulin resistance index(HOMA-IR),as well as the detection and comparison of stress indicators(c-reactive protein and white blood cells).Relative indexes of subjective comfort(thirst,hunger and anxiety)were compared 1 hour before and 1 hour after surgery.The incidence of intraoperative aspiration,postoperative nausea,vomiting and abdominal distension was compared between the two groups.Part 2: The effect of postoperative nutrition management on patients with lumbar disc herniation under the concept of ERASSelecting the second hospital of shanxi medical university orthopaedic spinal line of 100 hospitalized patients with lumbar disc surgery and were randomly divided into two groups according to the ward: treatment group(50 cases)and control group(50 cases).Patients in the control group were given a traditional postoperative feeding plan.The patients in the experimental group were given postoperative nutrition management scheme under the concept of ERAS.The others were performed according to hospital routine.The stress indicators were measured and compared 1 day before surgery,1st day and 3rd day after surgery: C-reactive protein(CRP),white blood cells(WBC),and nutrition indicators: anterior white Protein(PA),serum albumin(ALB),hemoglobin(HGB)1 day before surgery and 3 days after surgery.compare the subjective comfort related indicators 3 hours after surgery(thirst,hunger,anxiety)and the gastrointestinal symptoms within 24 hours after surgery: The incidence of nausea,vomiting,and bloating;comparing the patient’s first time to resist solid food,first exhaust time,and length of hospital stay.Results: Part 1: Effects of preoperative oral carbohydrate intake on insulin resistance in patients undergoing lumbar disc herniation1.Blood glucose,insulin and HOMA-IR: There was no significant difference between the two groups 3h before surgery(P>0.05).On the first day after the operation,all indexes of the two groups were increased,compared with the 3 h before the operation,but the increase rate of the experimental group was significantly lower than that of the control group(P<0.05).On the 3rd day after the operation,blood glucose was no difference between the two groups(P>0.05),Insulin and HOMA-IR were still higher in the control group than in the experimental group(P<0.05).2.Stress indicators: repeated measurement data variance analysis showed differences in indicators between the two groups(P<0.05).T test showed no significant difference between CRP and WBC at 3 h before surgery(P>0.05),CRP and WBC in the experimental group were lower than those in the control group on the 1st and 3rd day after surgery(P>0.05).3.Subjective perception VAS score: Compared with the control group,Hunger and anxiety at 1 hour after operation and hunger at 1 hour before operation were improved in the experimental group,and the difference was statistically significant(P<0.05),and thirst and anxiety at 1 hour berore operation and thirst at 1 hour after operation were no statistically significant difference(P>0.05).4.Complications: two groups of patients with postoperative malignant comparative incidence of vomiting,abdominal distension,there were no statistically significant difference(P>0.05),two groups of patients with intraoperative aspiration was not found.Part 2: The effect of postoperative nutrition management on patients with lumbar disc herniation under the concept of ERAS1.Stress index: there was no statistically significant difference between the two groups on the first day before the operation(P>0.05).On the first day after the operation,all indexes of the two groups were increased,compared with the first day before the operation,but the increase rate of the experimental group was significantly lower than that of the control group(P<0.05).On the third day after the operation,there was a decrease and all indexes in the control group were still higher than that in the experimental group(P<0.05).2.Nutritional indicators: there was no statistically significant difference between the two groups on the first day before the operation(P>0.05).On the third day after the operation,all the indicators in the two groups were decreased compared with the first day before the operation.The difference in ALB between the two groups was statistically significant(P<0.05),but the difference in PA and HGB was not statistically significant(P>0.05).3.Other observation indicators: compared with the control group,hunger,thirst and anxiety were significantly improved in the experimental group 3 hours after the operation before eating,with statistically significant difference(P<0.05).The complications of abdominal distension in the experimental group decreased within 24 hours after surgery,and the difference between the two groups was statistically significant(P<0.05).The duration of first postoperative tolerance to solid food and the duration of first anal exhaust and hospitalization in the experimental group were shorter than that in the control group,with statistically significant differences(P<0.05).Conclusion:1.oral carbohydrate solution 2 hours before operation help maintain patients perioperative metabolic balance,reduce postoperative insulin resistance and stress reaction,improve perioperative patients discomfort,and do not increase the intraoperative aspiration,risk of postoperative nausea and vomiting,abdominal distension complications as a result,preoperative oral carbohydrate is an important part of the accelerated rehabilitation,worth clinical promotion.2.Postoperative nutritional management under the concept of ERAS can reduce the stress response of patients,improve postoperative discomfort,shorten the first postoperative anal exhaust time and hospital stay,and accelerate the recovery of patients.Therefore,postoperative nutritional management under the concept of ERAS is beneficial to patients undergoing lumbar disc herniation surgery,which is worthy of clinical promotion. |
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