目的 探讨老年髋关节骨折患者实施个性化术前禁食方案的效果。方法 选择2016-06至2017-12行髋关节骨折患者110例,按照随机数字表法分为试验组(57例)和对照组(53例)。对照组患者实施传统术前一晚22时禁食、24时禁饮的方案,试验组患者通过对手术时间进行分层,制定个性化禁食方案。比较两组患者在术前实际禁食、禁饮时间,中重度口渴、中重度饥饿发生率,术后应激性高血糖发生率、术后 24 h 恶心呕吐发生率及住院时间的差异。结果 试验组实际禁饮时间[(6.52±2.46) h]短于对照组[(12.79±3.56)h],试验组实际禁食时间[(13.26±2.13)h]短于对照组[(14.85±1.99) h],差异均有统计学意义(P<0.001);试验组中重度口渴(1.75%)、饥饿发生率(5.26%)均低于对照组(18.87%,33.96%),差异均有统计学意义(P<0.05)。试验组术后应激性高血糖发生率(0%)低于对照组( 9.43%),24 h恶心呕吐发生率(1.75%)低于对照组(13.2%),差异均有统计学意义(P=0.021);试验组住院天数[(5.64±0.49)d]短于对照组[(7.80±1.04)d],差异有统计学意义(P=0.004)。 结论 个性化术前禁食方案可缩短术前禁食禁饮时间,降低术前饥饿、口渴发生率,降低术后应激性高血糖、恶心呕吐的发生率,且不增加术后误吸的发生,增加舒适感,缩短住院天数。

Objective To investigate the effect of personalized preoperative fasting plans on elderly hip replacement patients.Methods Using the random number table method, patients who underwent hip replacement surgery between June 2016 and December 2017 were divided into the experimental group and control group. In the control group, 53 patients received traditional preoperative fasting plans while 57 patients in the experimental group received personalized fasting schemes. By evaluating the conditions of patients and estimating the time of operation, the patients were given individualized drinking before surgery. The actual duration of fasting and water-deprivation, moderate to severe thirst, moderate to severe hunger, postoperative stress hyperglycemia, the incidence of nausea and vomiting during postoperative 24 h, and hospital stay were compared between the two groups.Results The actual duration of water-deprivation[(2.39±0.58) h] was shorter in the experimental group than [(13.96±11.39)h]in the control group, so was the duration of actual fasting time[(7.76±0.92)h vs (16.08±1.60). h], and the difference was statistically significant. The incidence of severe thirst (1.75%) and hunger (5.26%) in the experimental group was lower than that in the control group (18.87%, 33.96%), so the difference was statistically significant. The rate of post-stress hyperglycemia (0%) was lower than that of the control group (9.43%), so was the incidence of nausea and vomiting at 24 h [(1.75%) vs (13.2%)]. The difference was statistically significant. Hospital stay in the experimental group (5.64±0.49) d was significantly shorter than that of the control group (7.80±1.04) d, and the difference was statistically significant.Conclusions The implementation of the personalized preoperative fasting program can effectively shorten the time of fasting before surgery, reduce preoperative hunger, thirst, and the incidence of preoperative hypoglycemia and postoperative nausea and vomiting. The incidence of postoperative aspiration can be reduced, patients’ mood boosted and hospital stay shortened.