| Part I Application of preoperative multidimensional carbohydrate load in elderly patients with painless colonoscopyObjective: To investigate the effect of preventive oral multi-dimensional carbohydrate load on hemodynamics,postoperative fatigue syndrome,anesthesia satisfaction and incidence of adverse events in elderly patients with painless colonoscopy,so as to provide the basis for clinical optimization of elderly patients with painless colonoscopy before anesthesia.Methods: 1.This was a prospective,single blind,randomized controlled trial approved by the ethics committee of the Affiliated Hospital of Zunyi Medical University(formerly Zunyi Medical College)(see Appendix 1 ethics 12018-069,China clinical trial center registration number: Chictr19000026391).120 elderly patients with painless colonoscopy were randomly divided into three groups(n = 40): control group,intravenous infusion group(intravenous infusion of sodium,potassium,magnesium,calcium and glucose injection)and Outfast group(oral multi-dimensional carbohydrate).The control group was prepared according to the traditional bowel preparation without rehydration intervention;the intravenous infusion group received 500 ml sodium,potassium,magnesium,calcium,calcium and glucose injection at a constant speed within 2 hours before painless colonoscopy in the control group;the patients in Outfast group took 5ml / kg of Outfast 2 hours before painless colonoscopy,and the maximum dose was not more than 400 ml.2.Test information collection:(1)The baseline data were collected: gender,age,nationality,height,weight,history of hypertension and other information.The vital signs of resting state were recorded: mean arterial pressure(map),heart rate(HR),pulse oxygen saturation(Sp O2),ASA grade,thirst and hunger visual analog scale(VAS).(2)All patients were anesthetized with fentanyl and propofol.The changes of vital signs and hemodynamics in the post anesthesia care unit(PACU)were observed during the perianesthesia period,during the colonoscopy operation period and after anesthesia.Vital signs were recorded immediately before anesthesia induction(T0),immediately after anesthesia induction(T1),at the time of entering the mirror(T2),and immediately after entering PACU(T3).In case of circulatory respiratory depression during the perioperative period,the following measures should be taken:(1)the map of the right upper limb decreased more than or equal to 30% before the operation,and 5mg ephedrine was given;if the pulse rate was less than or equal to 50 times / min,atropine was given 0.25 mg;(2)hypoxemia: jaw support manipulation was performed,nasopharynx ventilation or oropharyngeal airway was placed if necessary,and oxygen inhalation flow was increased or even pressure oxygen was given by mask.Other patients were treated with routine emergency treatment.Based on the examination position,the blood pressure of the right upper limb was measured in all patients in the left decubitus position at all times.(3)The dosage and times of ephedrine,the operation time of colonoscopy and the dosage of propofol were recorded.(4)The recovery time and PACU stay time were recorded.(5)Adverse events were recorded: hypoxemia,severe hypotension,prolonged recovery time,postoperative nausea and vomiting(PONV).(6)The scores of thirst and hunger were evaluated.(7)The chief anesthesiologist,PACU nurses and subjects were asked to fill in the satisfaction survey score sheet.(8)The patients were asked to score the postoperative fatigue syndrome(POFS)immediately before leaving the PACU.The patients were followed up by telephone 24 hours after colonoscopy,and the POFS score was performed again.Results: 1.Baseline data There was no significant difference in gender,age,BMI,nationality,vital signs,thirst score,and VAS score of starvation among the three groups(P > 0.05).2.Hemodynamics(1)Map: immediately before anesthesia induction(T0),immediately after anesthesia induction(T1),immediately after PACU(T3),there was no significant difference in map among the three groups(P > 0.05);map at the time of entering the mirror(T2),oral surgery group and intravenous infusion group was higher than that of the control group(P < 0.05).(2)HR: at T0 and T2,HR in the oral surgery group and intravenous infusion group was lower than that in the blank control group(P < 0.05),but there was no significant difference between the two groups(P > 0.05);at T1 and T3,there was no significant difference among the three groups(P > 0.05).(3)Sp O2(%): at T0,T1,T2,T3,there was no significant difference between the two groups(P > 0.05).3.Use of vasoactive drugs,operation time of colonoscopy and dosage of propofol The use rate and repeated use rate of vasoactive drugs in Outfast group and intravenous infusion group were lower than those in control group(P < 0.05),and there was no significant difference between Outfast group and intravenous infusion group(P > 0.05);there was no significant difference in enteroscopy operation time and propofol dosage among three groups(P > 0.05).4.Recovery time and PACU stay time The recovery time and PACU stay time of Outfast group and intravenous infusion group were less than those of control group,the difference was statistically significant(P < 0.05);there was no significant difference between Outfast and intravenous infusion group(P > 0.05).5.Occurrence of adverse events(1)There was no significant difference in the incidence of hypoxemia among the three groups(P > 0.05).(2)The incidence of severe hypotension,PONV and prolonged recovery time in Outfast group and intravenous infusion group were lower than those in the control group(P < 0.05);there was no significant difference between the two groups(P > 0.05).6.Thirst score and hunger score The scores of thirst and hunger were lower in Outfast group and the intravenous infusion group than those in the control group(P < 0.05),and the difference was statistically significant(P < 0.05).7.Subject score,anesthesiologist score and PACU nurse score The scores of subjects and anesthesiologists in Outfast group and intravenous infusion group were higher than those in the control group(P < 0.05),but there was no significant difference between the two groups(P > 0.05);there was no significant difference in the scores of PACU nurses among the three groups(P > 0.05).8.POFS scores before and 24 hours after PACU(1)Before leaving PACU,the POFS score of Outfast group and intravenous infusion group was lower than that of control group,the difference was statistically significant(P < 0.05),but there was no significant difference between Outfast group and intravenous infusion group(P > 0.05).(2)POFS score after 24 hours: there was no significant difference among the three groups(P > 0.05).Conclusion: Preoperative oral multi-dimensional carbohydrate loading and intravenous infusion of sodium,potassium,magnesium,calcium and glucose injection can improve the hemodynamic stability of elderly patients during colonoscopy,and reduce POFS immediately after operation.Both of the two methods can reduce postoperative thirst and hunger,and the effect of oral multi-dimensional carbohydrate before operation is better,and patients’ satisfaction is higher.Part Ⅱ: Application value of bedside ultrasonography in preoperative multi-dimensional carbohydrate loading in painless gastroscopyObjective:Based on the first part of preoperative oral multi-dimensional carbohydrates for relieving thirst and hunger,this part applied bedside ultrasound to evaluate the safety and effectiveness of oral multi-dimensional carbohydrates in patients with painless gastroscopy 2 hours before operation,and to evaluate the application value of bedside ultrasound in the evaluation of gastric contents before painless gastroscopy.Methods: 1.This was a prospective,single blind,randomized controlled trial approved by the ethics committee of the Affiliated Hospital of Zunyi Medical University(see Annex 1.Ethics 2,klly-2019-107,China clinical trial center registration number: Chi)Methods: from August 2020 to September 2020,80 patients with gastrointestinal diseases in our hospital and underwent painless gastroscopy were randomly divided into two groups: control group(n = 40)and oral multi-dimensional carbohydrate group(operation group,n = 40).The control group was prepared according to the traditional gastroscope,without rehydration intervention;the Outfast group took 5 ml / kg of Outfast 2 hours before operation,and the maximum dose was not more than 400 ml.2.Test information collection(1)Collect baseline data,same as the first part.(2)Qualitative and quantitative evaluation of gastric fluid by bedside ultrasound: the same anesthetist trained by ultrasound was used Philips portable ultrasound lumify to evaluate the content of the stomach in the horizontal and right lying position respectively,and the time of completion of the examination was recorded.After the ultrasonic examination,the bed was moved to the area to be examined immediately,and ECG monitoring was conducted.The patients were placed in the left side and started the gastroscopy.(1)After entering the gastroscope preparation room,the patients were scanned in the supine position and then in the right decubitus position.The convex array low-frequency probe,frequency 2-5mhz,was evenly coated with coupling agent.The probe was longitudinally placed in the skin of the patient under the xiphoid process.The probe was slightly rotated in the parasagittal plane to scan the upper abdomen.The gastric antrum was identified at the level of aorta,superior mesenteric artery or inferior vena cava,and the sagittal plane between the left lobe of liver and pancreas,and the frozen image of gastric antrum was selected.Qualitative analysis was performed to determine the contents of gastric antrum and determine the nature of the contents: liquid and / or solid.(2)The gastric juice was semi quantitatively evaluated by perlas three-point scoring system to determine the gastric antrum grading(grade 0,1,2): 0 means that there is no gastric content in the antrum in the supine position and the right decubitus position,so the risk of aspiration is low;the score of 1 indicates that there is no gastric content in thesupine position,and the gastric content in the right decubitus position is liquid body,so the risk of aspiration is low;the score of 2 indicates that there is obvious gastric juice in the supine position and the right decubitus position,and the aspiration risk is low The risk was high;3 points indicated that the stomach was solid content,and the risk of aspiration was high.0-1 points for fasting,2-3 points for full stomach.(3)Procedures.The vertical diameter of gastric antrum was measured in the right decubitus position: head tail diameter(D1),anteroposterior diameter(D2),and cross sectional area(CSA)=(π× D1 × D2)/ 4 was calculated.(4)According to the criteria of adult full stomach: no gastric content was determined by perlas score 0 or perlas score 1 but CSA < 340 mm2;moderate gastric content was determined by perlas score of 1 point and CSA > 340 mm2;and it was judged as full stomach according to perlas score of 2,regardless of the size of CSA.(3)Anesthesia method,intraoperative complications treatment are the same as the first part.The changes of vital signs and hemodynamics were observed during anesthesia,gastroscopy and PACU.The vital signs map,HR and Sp O2 were recorded immediately before anesthesia induction(T0),immediately after anesthesia induction(T1),at the time of entering the mirror(T2),and immediately after PACU(T3);the dose and frequency of application of vasoactive drug ephedrine were recorded.(4)After entering the endoscopy,the endoscopist should start to attract the gastric contents from the stomach body when entering the endoscope until the gastric fundus attracts the gastric contents from the side hole of the gastroscope to the collecting bag to observe the nature of the attraction and measure its volume;record the postoperative diagnosis.(5)The correlation between CSA and gastric juice volume was analyzed.(6)Ask the gastroscope operator to score the gastric peristalsis.(7)The operation time of gastroscope and the dosage of propofol were recorded.(8)The recovery time and PACU stay time were recorded.(9)Adverse events were recorded: reflux aspiration,choking,hypoxemia,severe hypotension,delayed recovery,PONV.(10)The hunger and thirst scores were evaluated.(11)The chief anesthesiologist,endoscopist,PACU nurse and subjects filled in the satisfaction survey scale respectively.(12)The patients were asked to take POFS score before leaving PACU.24 hours after gastroscopy,the patients were followed up by telephone,and POFS score was performed again.Results: 1.Baseline data There was no significant difference in gender,age,BMI,nationality,vital signs in resting state,thirst score and hunger score between the two groups(P > 0.05).2.Qualitative and quantitative evaluation of intragastric fluid by bedside ultrasound(1)All patients were evaluated by bedside ultrasound within 5 minutes.No solid was found in the gastric contents of all patients.(2)There were 17 cases(17 / 40,42.5%)in the control group and 22 cases(22 / 40,55%)in the operation group.There were no stomach contents in the supine position and right lateral position in the control group(17 / 40,42.5%)and 18 cases(18 / 40,45%)in the operation group without gastric contents in the supine position,and the perlas score was 1 point.There was no significant difference between the two groups(P > 0.05).(3)Two groups of 80 patients were successfully measured CSA,including 1 case in the control group and 2 cases in the operation group,CSA exceed 340 mm2 in the other 77 patients.There was no significant difference in antral volume between the two groups(P > 0.05).3.Hemodynamics and ephedrine use(1)MAP,HR,Sp O2(%): at T0,T1,T2,T3,there was no significant difference between the two groups(P > 0.05).(2)There was no significant difference in the utilization rate and repeated use rate of ephedrine between the two groups(P > 0.05).4.Gastric juice volume Among the 80 patients,there were 37 cases of chronic non atrophic gastritis,13 cases of gastric erosion,11 cases of gastric polyps,7 cases of bile reflux gastritis,6 cases of gastric ulcer,4 cases of duodenal ulcer and 2 cases of chronic gastritis combined with gastric ulcer.There was no significant difference in gastric juice volume between the two groups(P > 0.05).5.There was a positive correlation between CSA and gastric juice volume in 80 patients of the two groups,the correlation coefficient was 0.709,P = 0.001.6.Gastric peristalsis score There was no significant difference in gastric peristalsis score between the two groups(P > 0.05).7.Gastroscope operation time and propofol dosage There was no significant difference in gastroscope operation time and propofol dosage between the two groups(P > 0.05).8.Recovery time and PACU stay time The recovery time and PACU stay time in the operation group were significantly shorter than those in the control group(P < 0.05).9.Occurrence of adverse events(1)Reflux aspiration did not occur in both groups.(2)There was no significant difference in cough,hypoxemia and severe hypotension between the two groups(P > 0.05).(3)The incidence of PONV and prolonged recovery time in the oral surgery group was lower than that in the control group(P < 0.05).10.Out of room thirst and hunger scores The VAS scores of postoperative thirst and hunger in the operation group were lower than those in the control group,the difference was statistically significant(P < 0.05).11.Subject score,anesthesiologist score,gastroscope operator score and PACU nurse score. (1)The score of patients in the operation group was higher than that in the control group(P < 0.05).(2)There was no significant difference in the scores of anesthesiologist,gastroscope operator and PACU nurse between the two groups(P > 0.05).12.Pof S score after leaving the room and Pof S score after 24 hours(1)The POFS score of the operation group was lower than that of the control group(P < 0.05).(2)24 hours later,there was no significant difference in POFS score between the two groups(P > 0.05).Conclusion(1)Bedside ultrasound can quickly evaluate the gastric contents of patients with painless gastroscopy before examination,which can be used as the basis for assessing the risk of reflux aspiration before gastroscopy,and has high value in improving the safety of operation.(2)Oral administration of multi-dimensional carbohydrates 2 hours before operation did not increase the volume of gastric contents.It could significantly reduce postoperative thirst and hunger,shorten the recovery time and PACU stay time of patients with painless gastroscopy,reduce PONV and postoperative Pof S,and increase patients’ comfort satisfaction. |
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