| Research Purpose: 1.The purpose of this study was to investigate the efficacy and safety of preoperative oral carbohydrates in patients undergoing endoscopic submucosal dissection;2.To provide scientific basis for the perioperative nursing of endoscopic submucosal dissection(ESD),improve patient comfort,maintain a stable internal environment,and promote early recovery.Meanwhile,it formed a scientific and effective preoperative feeding and nursing plan for accelerated rehabilitation surgery,and provided new ideas for the formation of scientific and effective preoperative fasting and drinking methods..Research Methods: This study was a randomized controlled trial.50 patients who were hospitalized in the gastroenterology department of a tertiary hospital from January 2020 to December 2020 were selected for upper gastrointestinal ESD according to the criteria for inclusion and exclusion.They were divided into two groups according to the random number table method.The experimental group was given 12.5% oral carbohydrates solution before operation,and the control group was routinely fasted before operation.The subjective comfort and feelings(thirst,hunger,fatigue and anxiety),glucose metabolism,vital signs and functions(grip strength,gastrointestinal function),hospital stay and cost,safety and other subjective and objective indicators of the two groups before and after the intervention were compared.Research Results: 1.Baselline comparison of subjects between the two groups in gender,age,education,occupation,esophageal/gastric surgery history,marital status,body mass index(BMI),american society of anesthesiologists(ASA)classification,lesion location,lesion type,lesion size and operation time showed no statistical differences(P > 0.05).Before intervention,there were no statistically significant differences in thirst,hunger,fatigue,anxiety,blood glucose,insulin resistance index and grip strength between the two groups(P > 0.05).2.Subjective comfort and feelings(1)Thirst score:(1)There were statistically significant differences in grouping effect,time effect and interaction effect of thirst score between the two groups(P<0.05).(2)Comparison between groups: There was no statistically significant difference in baseline comparison between the two groups on the 1st day before surgery(that is,before intervention)(P>0.05);the difference between the two groups was statistically significant before anesthesia and on the 1st day after surgery(P<0.05),the thirst score of the experimental group was lower than that of the control group.(3)Intra-group comparison: The differences in the thirst scores of the three time nodes in each group were statistically significant(P<0.05).As time went by,the thirst scores showed a gradual upward trend.Pairwise comparison within the group: The differences in the pairwise comparison of the subjects in each group at the three time nodes were statistically significant(P<0.05).(2)Starvation score:(1)There were statistically significant differences in grouping effect,time effect and interaction effect of starvation score between the two groups(P<0.05).(2)Comparison between groups: There was no statistically significant difference in baseline comparison between the two groups on the 1st day before surgery(P>0.05);the difference between the two groups before anesthesia was statistically significant(P<0.05),and the experimental group had a lower starvation score than the control group;there was no statistically significant difference between the two groups on the 1st day after surgery(P>0.05),but from a numerical point of view,the starvation score of the experimental group was slightly lower than that of the control group.(3)Intra-group comparison: The differences in the starvation scores of the subjects in each group at the three time nodes were statistically significant(P<0.05).With the passage of time,the starvation scores showed a gradual upward trend.Further pairwise comparison: There was no significant difference in starvation score between the control group before anesthesia and the 1st day after surgery(P>0.05),and the pairwise comparison at the other time points showed statistical significance(P<0.05).(3)Fatigue degree:(1)Comparison between groups: There was no statistically significant difference in baseline comparison between the two groups on the 1st day before surgery(P>0.05),and the difference between the two groups on the 2nd day after surgery was statistically significant(P<0.05).The fatigue degree of the experimental group was lower than that of the control group;the fatigue degree difference between the 1st day before the operation and the 2nd day after the operation showed a statistical difference(P<0.05),and the experimental group was lower than the control group.(2)Intra-group comparison: The differences within each group were statistically significant(P<0.05),and the degree of fatigue on the 2nd day after operation was higher than that before operation.(4)Anxiety degree:(1)Comparison between groups: There was no statistically significant difference between the two groups on the 1st day before operation and before anesthesia(P>0.05),but the difference in anxiety degree between 1st day before operation and before anesthesia was statistically significant(P<0.05),and the experimental group was smaller than the control group.(2)Intra-group comparison: The differences within each group were statistically significant(P<0.05),and the degree of anxiety before anesthesia was higher than 1st day before surgery.3.Sugar metabolism(1)Blood glucose:(1)There were statistically significant differences in grouping effect,time effect and interaction effect of blood glucose between the two groups(P<0.05).(2)Comparison between groups: There was no statistically significant difference in baseline comparison between the two groups on the 1st day before surgery(P>0.05);the difference between the two groups before anesthesia was statistically significant(P<0.05),and the blood glucose level of the experimental group was higher than the control group.They were all within the normal range;there was no statistically significant difference between the two groups on the 1st day after surgery(P>0.05).(3)Comparison within the group: The difference in blood glucose levels between the three time points in the experimental group was statistically significant(P<0.05).Further pairwise comparison: There were statistical differences in the blood glucose values between the day before anesthesia and the 1st day before surgery,and between the day before anesthesia and the 1st day after surgery(P < 0.05),while there was no statistical difference between the 1st day after surgery and the 1st day before surgery(P > 0.05).The difference in blood glucose levels between the three time points in the cintrol group was statistically significant(P<0.05).The blood glucose level of the experimental group increased from the 1st day before the operation to the pre-anaesthesia stage,and it decreased from the pre-anaesthesia to the 1st day after the operation.The pre-anaesthesia blood glucose level was the highest,but all were within the normal range;the blood glucose of the control group fluctuated gently over time.(4)Comparison of the incidence of low blood glucose level: There was no statistically significant difference between the two groups before operation(P>0.05);the difference between the two groups before anesthesia was statistically significant(P<0.05),and there was no blood glucose level in the experimental group before anesthesia below the lower limit of normal value of 3.9mmol/L,4 cases in the control group were lower than the lower limit of normal value,but none of them were lower than the hypoglycemia standard of 2.8mmol/L;there was no significant difference between the two groups on the 1st day after surgery(P>0.05).(2)Insulin resistance index:(1)Comparison between groups: There was no statistically significant difference between the two groups on the 1st day before surgery and the 1st day after surgery(P>0.05),but the difference in insulin resistance index between the two groups showed that there was statistical difference(P<0.05),the experimental group was larger than the control group.(2)Comparison within the group: The difference within the experimental group was statistically significant(P<0.05),the insulin resistance index on the 1st day after surgery was lower than the 1st day before surgery;the comparison within the control group was not statistically significant(P>0.05).4.Vital signs and functions(1)Grip strength value:(1)There was no statistical significance in the grouping effect of grip strength value between the two groups(P>0.05),while the time effect and interaction effect showed statistical significance(P<0.05).(2)Comparison between groups: There was no statistically significant comparison between the two groups at the three time nodes on the 1st day before operation,pre-anesthesia and the 1st day after operation(P>0.05).(3)Intra-group comparison: There was statistical significance in the experimental group(P < 0.05);Further pairwise comparison: there was no statistical difference between the 1st day before operation and pre-anesthesia(P > 0.05),and there were statistical differences between the 1st day after operation and the 1st day before operation,and between the 1st day after operation and pre-anesthesia(P < 0.05).There was statistically significant difference in the control group(P < 0.05).Further pairwise comparison: there were statistical differences among the three time nodes(P < 0.05).The grip strength values of each group showed a downward trend over time.(2)Recovery of gastrointestinal function: There was no significant difference between the two groups of subjects in the time of first exhaust and the time of first defecation after surgery(P>0.05).5.Adverse events and complications: There was no case of regurgitation aspiration in the two groups during operation.There was no significant difference in the incidence of nausea and vomiting,abdominal pain and abdominal distension score,and incidence of bleeding and perforation(P>0.05).6.Hospitalization time and hospitalization expenses: There was no statistically significant difference in hospitalization time and hospitalization expenses between the two groups of study subjects(P>0.05).Research Conclusion: This study proved that preoperative oral carbohydrates could relieve the subjective feelings and psychological responses of patients with upper gastrointestinal ESD patients such as thirst,hunger,fatigue,etc.,and improve the subjective comfort of patients during the perioperative period,thereby reducing the occurrence of physical and psychological stress.In addition,preoperative oral carbohydrates can increase the patient’s pre-anaesthetic blood sugar,achieve a moderate energy reserve,reduce the risk of preoperative hypoglycemia,and do not increase the occurrence of adverse reactions and complications.This treatment will not increase the economic burden of patients such as hospitalization costs.Preoperative oral carbohydrates can maintain the grip strength of upper gastrointestinal ESD patients before anesthesia,but the postoperative sustained effect is not significant,and it has a certain impact on patients’ anxiety and insulin resistance.However,the effects on gastrointestinal function recovery and hospital stay were not significant,which may be related to the insufficient or duration of preoperative carbohydrate administration,resulting in insufficient statistical changes,which need to be further explored in the future.Based on the results of this study,the preoperative oral carbohydrate regimen for patients with upper gastrointestinal ESD is safe and feasible,and the overall effect is satisfactory,which is worthy of recommendation. |
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