Effect Of Oral 10% Glucose Solution With Different Volume On Comfort Level Of Patients With Painless Gastroenteroscopy

Objective:To investigate the effects of oral administration of 10%glucose solution with different volumes 2 hours before surgery on comfort,hemodynamics and safety of patients with painless gastroenteroscopy,and to provide appropriate oral volume reference for its application before painless gastroenteroscopy.Method:1.This study was approved by the Ethics Committee of the Affiliated Hospital of Yan’an University（registration number of Chinese Clinical Trial Center:Chi CTR2200058028）.Clinical data of healthy patients who underwent painless gastroenteroscopy in the Affiliated Hospital of Yan’an University from April 2022 to August 2022 were prospectively analyzed,and a single-blind randomized controlled trial was conducted.A total of 120 patients who met the inclusion and exclusion criteria were randomly divided into control group（group A）and experimental group（group B1）,group 300mL（group B2）and group 400mL（group B3）according to the ratio of 1:1:1:1（random number table method）.The control group did not receive any intervention according to the traditional intestinal preparation and forbidden diet standards.In the experimental group,200,300,400mL of warm 10%Glucose Solution（GS）were taken orally 2 hours before anesthesia.All patients in 4 groups received preoperative education,popularization of anesthesia and surgical procedures.The anesthesiologist and surgeon did not know the group of patients.2.Data collection:（1）Gender,age,height,weight and ASA classification of patients;Baseline vital signs:heart rate（HR）,oxygen saturation（SpO₂）,mean arterial pressure（MAP）;（2）Visual analog scores（VAS）of thirst and hunger before intervention and anesthesia induction;（3）The frequency of urination within 2 hours before surgery was recorded in the four groups.（4）Hemodynamic changes were observed:HR,SpO₂ and MAP of the four groups were recorded immediately before anesthesia induction（T0）,at the beginning of gastroscopy（T1）,5 minutes after surgery（T2）,20 minutes after surgery（T3）,and PACU（T4）in the recovery room after anesthesia.（5）Semi-quantitative assessment of stomach contents under bedside ultrasound 3 minutes before anesthesia（Perlas three-stage scoring system）;（6）Ask the gastroscopy doctor to aspirate the patient’s stomach contents to the maximum extent from the stomach body to the stomach fundus,measure its volume（M）and measure its PH with PH test paper;（7）Postoperative fatigue（POFS）scores were performed;（8）Adverse reactions were recorded:hypoxemia,HR<50bpm,severe hypotension（MAP decreased by more than 30%before surgery）,postoperative nausea and postoperative vomiting.Results:A total of 120 patients were included in this study,of which 1 patient in group B1 was excluded after taking oral water by himself after intervention,and 1 patient in group B3 was excluded because he could not take oral 400mL solution at one time.Finally,118 patients were analyzed statistically.1.General data1.1 There were statistically significant differences in gender,age,height,weight,ASA classification and vital signs in the four groups（P>0.05）;1.2 There was no statistical significance in the dosage of propofol and fentanyl during the examination and the hunger and thirst score before intervention among the four groups（P>0.05）.2.Main indicators2.1 Preoperative hunger and thirst VAS scores:Group B1,B2 and B3 were significantly lower than group A,with statistical significance（P<0.05）;Group B2 and B3 were lower than group B1,and the difference was statistically significant（P<0.05）.There was no significant difference between B2 and B3 groups（P>0.05）.2.2 Postoperative POFS score:Group B2 and B3 were significantly lower than group A and B1,and the difference was statistically significant（P<0.05）.2.3 Hemodynamics（1）MAP:there was no significant difference in MAP at the immediate（TO）time before anesthesia induction among the four groups（P>0.05）;At the beginning of gastroscopy（T1）and 5 minutes after operation（T2）,groups B2 and B3 were significantly higher than groups A and B1,and the difference was statistically significant（P<0.05）.20min after operation（T3）and PACU（T4）time after entering the recovery room after anesthesia:Group B1,B2and B3 were higher than group A,the difference was statistically significant（P<0.05）.（2）HR:T0 moment:HR of B2 and B3 groups was significantly lower than that of group A,and the difference was statistically significant（P<0.05）;Group B3 was significantly lower than group B1,and the difference was statistically significant（P<0.05）.At T1,HR in groups B2 and B3 was significantly lower than that in groups A and B1,and the difference was statistically significant（P<0.05）.At T2,group B2 and B3 were significantly lower than group A,the difference was statistically significant（P<0.05）.Group B3 was lower than group B1,and the difference was statistically significant（P<0.05）.（3）SpO₂:There was no statistical significance in SpO₂ at T0,T1,T2,T3 and T4 among the four groups（P>0.05）.3.Secondary indicators3.1 Stomach contents and pH of gastric fluid:There was no significant difference in actual stomach volume between the four groups during gastroscopy（P>0.05）.There was no significant difference in pH of gastric juice among the four groups（P>0.05）.3.2 The number of urination within 2 hours before surgery:Group B1,B2 and B3 was significantly higher than group A,the difference was statistically significant（P<0.05）;Group B3 was significantly higher than group B1,and the difference was statistically significant（P<0.05）.The difference between B3 group and B2 group was statistically significant（P<0.05）.3.3 Tertiary Perlas score of gastric antrum ultrasound:there were 17 cases in group A（56.67%）,14 cases in group B1（48.28%）,16 cases in group B2（53.33%）and 15 cases in group B3（51.72%）,and the Perlas score was 0.The Perlas score of 13 patients in group A（43.33%）,15 patients in group B1（51.72%）,14 patients in group B2（46.67%）and 14patients in group B3（48.28%）was 1 point.There was no significant difference among the four groups in the Perlas three-point scoring system（P>0.05）.3.4 Occurrence of adverse reactions in the four groups:Postoperative nausea in group B3 was significantly lower than that in group A and B1,with statistical significance（P<0.05）,while there was no significant difference among the other groups（P>0.05）.Conclusion:Oral administration of 10%GS could improve the preoperative VAS scores of hunger and thirst,and the effect was more obvious in 300mL and 400mL groups.The 300mL and400mL groups can enhance the stability of MAP and HR during gastroenteroscopy,reduce the postoperative POFS score,and effectively reduce the incidence of postoperative nausea.Compared with the 300mL group,the 400mL group showed no significant improvement in each observation index,but significantly increased the frequency of patients’preoperative urination,poor patient compliance,which may increase patients’anxiety.Therefore,the appropriate oral volume is 300mL 2 hours before colonoscopy.