Effects Of Different Concentrations Of Sugary Drinks On The Stress Response Of Perioperative Patients:A Prospective Longitudinal Study

Objectives:To explore the effects of different concentrations of sugary drinks on perioperative blood glucose in the different periods,albumin,adrenocorticotropic hormone(ACTH),anxiety differences,thirst and hungry risk of patients,in order to provide clinical guidance and theoretical basis for regulating preoperative carbohydrate-containing drinks selection and perioperative blood glucose management and reducing the stress reaction of perioperative patients.Methods:This study is a prospective longitudinal study,from multiple time periods,exploring the effects of different concentrations of preoperative sugary drink on the stress response of perioperative patients.A total of 321 patients in neurosurgery,thoracic surgery,hepatobiliary surgery,gastrointestinal surgery,urology and spine surgery in a grade A hospital in jinan who underwent elective surgery under general anesthesia from July to October,2018 were enrolled.At 6:00 am on the operation day,the enrolled patients were divided into five groups according to the doctor's advice.The control group was group A,and the patients were forbidden to drink in the morning on the operation day according to the doctor's advice.In the other four exposure groups,at 6:00 am on the operative day,take 5%glucose with warm water,10%glucose with 10%glucose and 14.2%carbohydrate,and drink 350ml of intraoperative energy.The blood glucose of the patients were monitored within half an hour before surgery,1 to 2 hours after surgery,6 hours after surgery,and the morning after surgery.Serum albumin and corticotropin(ACTH)were monitored on admission and the morning after surgery.The stress response measure Tools included GAD-2 and visual analogue scales(VAS)to assess the level of anxiety and thirst and hunger of the patients respectively.SPSS21.0 software was used for statistical analysis of all data.Generalized Estimation Equation was used to compare the differences of blood glucose,albumin and ACTH at different time points in the five groups,and logistics regression was used to discuss the differences of preoperative and postoperative anxiety,thirst and hunger in different groupsResults:1.The comparison of general demographic data,disease-related data,perioperative conditions and biochemical indicators of admission of the patients in the five groups showed statistically significant differences in department(P<0.001),tumor nature(P<0.001)and waiting time for surgery(P=0.002),while the differences in other variables were not statistically significant.No reflux and aspiration occurred in the five groups.2.The difference in the effects of albumin,ACTH,anxiety,thirst and hunger among the five groups,2.1 Blood glucose:At Time 5(one day after surgery),blood glucose value of group C(5%glucose group)decreased by 1.40 mmol/L on average compared with group A(prohibition group),and the difference was statistically significant(B=-1.40,P=0.037);Compared with group A(abstinence group),group B(warm water group)showed an average decrease of 1.57mmol/L in blood glucose,and the difference was statistically significant(B=-1.57,P=0.036).At time 4(6 hours after surgery),blood glucose of group B(warm water)decreased by 1.45mmol/L on average compared with group A(prohibition group),and the difference tended to be statistically significant(B=-1.45,P=0.050).At time 3(1-2h intraoperatively),blood glucose level of group C(5%glucose group)decreased by 1.37mmol/L on average compared with group A(prohibition group),and the difference was statistically significant(B=-1.37,P=0,044)2.2 ACTH albumin:There were no statistically significant differences in ACTH albumin between different groups before and after surgery.2.3 Anxiety:Preoperative and postoperative anxiety of different groups showed no statistical significance.2.4 Thirst score:The oral drink group had A lower preoperative thirst risk than group A(abstinence group).Only group D(10%glucose group)had A lower postoperative thirst risk than group A(abstinence group).2.5 Hunger score:Compared with group A,the preoperative oral drink group had A lower risk of preoperative hunger.Only group B(warm water group)and group D(10%glucose group)had lower postoperative hunger risk than group A(abstinence group).Conclusion:1.This study confirmed that in general anesthesia patients without special risk of aspiration and gastric emptying disorder,oral administration of about 350ml of clear'beverage 2 hours before the operation would not increase the risk of intraoperative reflux and aspiration.2.The preoperative intake of sugary drinks or warm water could reduce the perioperative stress hyperglycemia.3.The surgery as a kind of traumatic stress,could lead to the psychological and physiological changes of the patients,causing the increase of stress blood glucose.4.Warm boiled water of sugary drinks before surgery could alleviate the sensation of thirst and hunger of patients and improve their comfort level.5.The perioperative stress response was affected by a variety of factors,and a series of perioperative optimization measures should be taken to reduce the perioperative stress response.