12.5%麦芽糊精果糖溶液在早期胃癌患者行内镜黏膜下剥离术中的应用研究

Preoperative oral administration of maltodextrin fructose solution in early gastric cancer patients undergoing endoscopic submucosal dissection

关键词:  碳水化合物  内镜黏膜下剥离术  早期胃癌  加速康复外科

Key words:  carbohydrate  endoscopic submucosal dissection  early gastric cancer  enhanced recovery after surgery

摘要:

目的探讨早期胃癌患者在行内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)术前口服12.5%麦芽糊精果糖溶液的有效性及适用性。 方法选取同济大学附属第十人民医院消化内镜中心收治住院的行ESD手术的早期胃癌患者作为研究对象，随机分为试验组和对照组。试验组于术前8 h口服12.5%麦芽糊精果糖溶液800 mL，术前2 h口服12.5%麦芽糊精果糖溶液400 mL；对照组行常规术前禁食禁饮。比较两组患者术前、术后第1天和术后第3天的血生化指标、炎症指标和主观舒适度评分（饥饿感、口渴感、疼痛感和焦虑感），比较手术前后患者的创伤后成长评定，并记录住院时间及费用。 结果根据纳入排除标准共收集患者116例，其中试验组57例，对照组59例。重复测量方差分析结果显示血糖、胰岛素、电解质指标、营养指标及炎症指标均随时间因素显著变化（P<0.05）。干预因素和时间因素对两组患者的血糖、胰岛素、白蛋白、淋巴细胞计数、钾、钠、钙、磷和镁是相互影响的（P<0.05）。与对照组相比，术前口服12.5%麦芽糊精果糖溶液能显著降低患者术后的饥饿感和口渴感（P<0.05）。PTGI变化表明患者经历创伤后成长更多，社会功能、认知功能及精神状态明显改善。试验期间两组均未出现反流误吸等并发症，两组患者术后出血、恶心呕吐、腹胀、腹痛等症状发生率比较，差异无统计学意义（P>0.05）。 结论行ESD的患者在术前口服12.5%麦芽糊精果糖溶液是可行和安全的，能有效降低炎症反应，缓解患者术后的饥饿感、口渴感及精神状态。

Abstract:

ObjectiveTo investigate the effectiveness and applicability of oral administration of maltodextrin fructose solution in patients with early gastric cancer before endoscopic submucosal dissection(ESD). MethodsA total of 116 patients with early gastric cancer undergoing ESD in Digestive Endoscopy Center of Shanghai Tenth People’s Hospital from July 2022 to April 2023 were randomly divided into study group(n=57) and control group(n=59). Patients in study group were given 800 mL of 12.5% maltodextrin fructose solution orally at 8 h and 400 mL at 2 h before surgery; those the control group were routinely abstained from food and water before surgery. Blood biochemical indexes, inflammatory indexes and subjective comfort scores(hunger, thirst, pain and anxiety) were compared between the two groups before and after surgery, and on the first and third day after surgery. The post traumatic growth inventory(PTGI) scores of patients before and after surgery were compared, and the length of hospital stay and cost were recorded. ResultsRepeated measurement analysis of variance showed that blood glucose, insulin, electrolytes, nutritional indexes and inflammatory indexes were significantly changed with time(P<0.05). Intervention factors and time factors had mutual effects on blood glucose, insulin, albumin, lymphocyte count, potassium, sodium, calcium, phosphorus and magnesium in the two groups(P<0.05). Compared with the control group, preoperative oral administration of 12.5% maltodextrin fructose solution in the study group significantly reduced postoperative hunger and thirst(P<0.05). Changes in PTGI scores indicated that in patients who experienced more post-traumatic growth, their social, cognitive and mental functions were significantly improved. There were no complications such as reflux aspiration in the two groups during the trial, and there was no significant difference in the incidence of postoperative bleeding, nausea and vomiting, abdominal distension and abdominal pain between the two groups(P>0.05). ConclusionOral administration of 12.5% maltodextrin fructose solution before surgery is feasible and safe for patients undergoing ESD, which can effectively reduce inflammatory response and relieve postoperative hunger, thirst and mental state of patients.