术前禁食禁饮时间对妇科腹腔镜手术患者围术期内环境及术后恢复的影响

Effects of nil per os duration on perioperative homeostasis and postoperative recovery in patients undergoing gynecologic laparoscopic surgery

摘要

目的 系统评估不同术前禁食禁饮（NPO）时间对妇科腹腔镜手术患者围术期电解质平衡、酸碱平衡、血糖变化、术中循环稳定性及术后恢复的影响，为优化围术期管理提供临床依据。方法 采用回顾性队列研究设计，纳入2025年3月至8月于广州医科大学附属妇女儿童医疗中心进行择期妇科腹腔镜手术的患者。根据NPO时间将患者分为3组：NPO＜14 h组（90例）、NPO 14～20 h组（145例）和NPO＞20 h组（27例）。收集患者一般资料、术中情况、动脉血气分析指标、电解质紊乱发生率、术后恢复指标等，比较组间差异。结果 共纳入262例妇科腹腔镜手术患者。入室时低钾血症发生率为80.53%，低钙血症为41.60%，低钠血症为24.81%，3组间差异无统计学意义（ P均＞0.05）。出室前低钾血症（46.56% vs. 80.53%）及低钠血症（23.66% vs. 24.81%）发生率较入室下降，但低钙血症未见改善。随NPO时间延长，入室pH值、碱剩余、血红蛋白及血细胞比容呈下降趋势（均 P＜0.05），代谢性酸中毒发生率在3组间差异有统计学意义（ P=0.035）。术中尿量随NPO时间延长而减少（ P=0.011），但术中低血压发生率、血管活性药物使用率及术后C反应蛋白水平间差异无统计学意义（ P均＞0.05）。首次下床活动时间、首次肛门排气时间及术后住院时间在3组间差异有统计学意义（ P均＜0.05）。结论 在术前补液策略下，NPO时间延长并未进一步加重入室时的电解质紊乱，但代谢性酸中毒风险随NPO时间延长而增加，尤其是NPO超过20 h者。术中尿量减少提示长时间禁食可能影响肾灌注。在无法实现推荐禁食方案的情况下，应加强术前电解质补充、关注酸碱失衡风险，并加强对肾灌注的术中监测，以促进患者术后康复。

Abstract

Objective To systematically evaluate the effects of different durations of nil per os (NPO) on perioperative electrolyte balance, acid-base balance, blood glucose changes, intraoperative circulatory stability, and postoperative recovery in patients undergoing gynecologic laparoscopic surgery, so as to provide clinical evidence for optimizing perioperative management. Methods A retrospective cohort study was conducted. Patients who underwent elective gynecologic laparoscopic surgery at Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, from March to August 2025 were included. According to NPO duration, the patients were divided into three groups: the NPO＜14 h group ( n=90), the NPO 14-20 h group ( n=145), and the NPO＞20 h group ( n=27). General patient data, intraoperative conditions, arterial blood gas analysis indicators, incidence of electrolyte disorders, and postoperative recovery indicators were collected, and differences among the groups were compared. Results A total of 262 patients undergoing gynecologic laparoscopic surgery were included. Upon entry to the operating room, the incidence of hypokalemia was 80.53%, hypocalcemia 41.60%, and hyponatremia 24.81%, with no statistically significant differences among the three groups (all P＞0.05). Before leaving the operating room, the incidence of hypokalemia (46.56% vs. 80.53%) and hyponatremia (23.66% vs. 24.81%) decreased compared with that upon entry, whereas hypocalcemia did not improve. With prolonged NPO duration, pH value, base excess, hemoglobin, and hematocrit upon operating room entry showed decreasing trends (all P＜0.05). The incidence of metabolic acidosis differed significantly among the three groups ( P=0.035). Intraoperative urine output decreased with prolonged NPO duration ( P=0.011), while there were no statistically significant differences in the incidence of intraoperative hypotension, use of vasoactive drugs, or postoperative C-reactive protein levels among the groups (all P＞0.05). Time to first out-of-bed activity, time to first flatus, and postoperative length of stay differed significantly among the three groups (all P＜0.05). Conclusions Under a preoperative fluid supplementation strategy, prolonged NPO duration did not further aggravate electrolyte disorders upon operating room entry. However, the risk of metabolic acidosis increased with prolonged NPO duration, especially in patients with NPO duration exceeding 20 h. Reduced intraoperative urine output suggested that prolonged fasting may affect renal perfusion. When the fasting regimen recommended by enhanced recovery after surgery (ERAS) cannot be implemented, preoperative electrolyte supplementation should be strengthened, the risk of acid-base imbalance should be closely monitored, and intraoperative monitoring of renal perfusion should be enhanced to promote postoperative recovery.

关键词

术前禁食 / 妇科腹腔镜手术 / 电解质紊乱 / 代谢性酸中毒 / 加速康复外科

Key words

Preoperative fasting / Gynecologic laparoscopic surgery / Electrolyte disorder / Metabolic acidosis / Enhanced recovery after surgery

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基金资助

广东省中医药局科研项目(20231263)

广州市科学技术局市校（院）企联合资助项目(2024A03J1243)