| Background:In clinical work,paying attention to the physical and mental health of patients is one of the key points in perioperative management based on the concept of accelerated rehabilitation.Surgery for a long time will have a great impact on the physiology and psychology of patients.It has been proved that ERAS strategy can reduce complications,improve cardiopulmonary function,promote rapid postoperative exhaust,promote the recovery of early intestinal function,get out of bed as soon as possible,shorten hospital stay,and cover the whole perioperative period.Shortening the time of fasting before operation and giving carbohydrate drinks 2 hours before operation can supplement certain energy before operation,reduce postoperative insulin resistance,improve the traumatic response caused by stress,and improve the perioperative experience of patients.promote rapid recovery after operation.More attention should be paid to the perioperative fasting management of obese patients.Obese patients are more likely to have many pathological changes than healthy people,and the risk of difficult airway is higher than healthy people.Shortening the time of fasting before operation needs individualization.Perioperative fasting management of obese patients needs to be more accurate.Objective:This study aims to use the ultrasound gastric volume detection technology to evaluate the safety of drinking carbohydrate beverages before elective surgery in obese patients,and whether to improve the patient’s perioperative experience,and provide clinicians with better treatment options.It also provides a better way to avoid drinking before the operation for obese patients,and provides a new clinical plan to promote rapid postoperative recovery,improve the anxiety of obese patients during the perioperative period,reduce postoperative complications and discomfort,and promote postoperative recovery.Methods:In this study,84 obese patients undergoing elective surgery were randomly divided into three groups.26 patients in the experimental group were given oral 250 ml carbohydrate beverage 2 hours before operation,28 patients in the drinking group were given oral 250 ml water 2 hours before operation,and 30 patients in the control group were routinely fasted.The cross-sectional area of gastric antrum(crosssectionalarea,CSA)was measured 2 hours before operation(T1),1 hour before operation(T2)and before anesthesia induction(T3),and the corresponding gastric volume(gastricvolume,GV)was calculated according to the formula,so as to evaluate the risk of regurgitation and aspiration(GV/W).All patients were assessed with self-rating anxiety scale(Self-rating Anxiety Scale,SAS)before anesthesia induction,hunger and thirst were evaluated with visual analogue scale(visualanaloguescale,VAS),the overall recovery quality was evaluated with Qo R-40 scale 24 hours after operation,and the incidences of perioperative reflux aspiration and postoperative nausea and vomiting were recorded.Statistical analysis using SPSS25.0 software showed that all the data were in accordance with normal distribution and were described by mean ±standard deviation.Among them,CSA,GV and GV/W were analyzed by repeated measurement analysis of variance(P < 0.0167),the total scores of SAS,hungry VAS,thirsty VAS,Qo R-40 and their sub-indexes were analyzed by single factor analysis of variance(P <0.05).The counting data were expressed by frequency and constituent ratio,and the differences between groups were compared by chi-square test.Results:Before anesthesia induction,there were significant differences in CSA 、 GV 、 GV/W in the experimental group and control group(P=0.009,P=0.011,P=0.016).There were no significant differences in CSA 、 GV 、 GV/W between the experimental group and the drinking water group(P=0.246,P=0.241,P=0.71).And there were no significant differences in CSA、GV 、GV/W between the control group and the drinking water group(P=0.129,P=0.156,P=0.036).After drinking carbohydrate drinks and water,the CSA and GV of the experimental group and the drinking water group increased at first and then decreased,and with the extension of time,the gastric volume increased at first and then decreased.There was no intervention in the control group,and there was no statistical difference(P > 0.0167).No aspiration occurred in all patients.The preoperative SAS score of the experimental group was lower than that of the control group(P=0.003).When compared with the experimental group and the control group,there was no statistical difference between the drinking water group and the control group(P=0.61,P=0.07).The preoperative hunger VAS score of the experimental group was lower than that of the drinking water group and the control group(P<0.001,P<0.001).There was no significant difference between the drinking group and the control group(P=0.078).Compared with the control group,the VAS of thirst in the experimental group and drinking water group was lower than that in the control group(P < 0.001,P < 0.001),but there was no significant difference between the experimental group and the drinking water group(P < 0.01).After operation,there was no significant difference in the total score of Qo R-40 between the experimental group and the drinking water group(P < 0.01),but the total score of the experimental group and the drinking water group was higher than that of the control group(P < 0.001,P < 0.001).In the evaluation of emotional state,the score of the experimental group was higher than that of the drinking group(P < 0.001),and the score of the experimental group and the drinking group was higher than that of the control group(P < 0.001).In terms of physical comfort,there was no significant difference between the experimental group and the drinking group(P < 0.001),but the experimental group and the drinking group were higher than the control group(P < 0.05).There was no significant difference in self-care ability between the experimental group and the drinking water group(P < 0.001),but the self-care ability of the experimental group and the drinking water group was higher than that of the control group(P < 0.001).Among the psychological support groups,there was no significant difference between the experimental group and the drinking water group(P < 0.01),but both the experimental group and the drinking water group were higher than those of the control group(P < 0.001,P < 0.001).In pain evaluation,the pain in the experimental group was lower than that in the control group(P < 0.05).There was no significant difference between the experimental group and the drinking water group,and between the drinking water group and the control group(P > 0.05).During the follow-up 24 hours after operation,nausea occurred in 7 cases(26.9%)and vomiting in 4cases(15.4%)in the experimental group,nausea in 6 cases(21.4%)and vomiting in 7 cases(25%)in the drinking group,and nausea in 10 cases(33.3%)and vomiting in 5 cases(16.7%)in the control group.There was no significant difference in nausea and vomiting among the three groups.Conclusion:1.It is safe to give obese patients oral 250 ml carbohydrate drinks or water 2 hours before operation.2.Oral 250 ml of carbohydrate drinks or water 2 hours before surgery can help reduce preoperative anxiety and thirst in obese patients,and can promote the overall recovery of patients after surgery,improve the patient’s physical comfort,and promote the recovery of self-care ability and psychological support.3.Oral 250 ml carbohydrate drinks 2 hours before surgery is more beneficial than clear water to reduce the patient’s preoperative hunger and emotional state recovery,and the former helps pain recovery.. |
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