CAJ | 학술논문

目的：探讨缩短口腔颌面外科全身麻醉手术患者麻醉清醒后进食的时间，减轻患者不适和不良反应，促进患者术后恢复。方法将2014年4~9月全身麻醉手术的160例口腔颌面外科患者，按随机数字表法分成对照组与观察组各80例，对照组遵医嘱给予全身麻醉清醒后6 h进流质饮食，观察组给予全身麻醉清醒后2h进水，4h进流质饮食，观察2组患者误吸、餐前外周血糖值、血压和心率及患者口渴、饥饿、恶心、呕吐等不适发生率。结果观察组口渴、饥饿、恶心、呕吐不适发生率显著低于对照组（4例比73例、15例比76例、10例比29例、1例比7例），P＜0.05，χ2值分别为119.19、94.83、12.24、4.74；观察组餐前外周血糖值高于对照组[（4.82±0.74）mmol/L比（4.06±0.62）mmol/L ]，P＜0.05，t=-7.04；2组误吸发生率均为0；对照组术后血压和心率低于术前，P＜0.05，收缩压、舒张压和心率的t值分别为：术后1 h-2.32、-2.03、-4.89；术后3 h-2.75、-10.54、-6.22；术后5 h-8.91、-14.76、-6.14；观察组术后1 h测定血压与术前比较差异无统计学意义，P＞0.05，收缩压、舒张压的t值分别为-2.73、-2.56。结论缩短口腔颌面外科全身麻醉手术患者意识完全清醒后进食时间，提前进水进食，可以缓解患者不适症状，避免低血糖，改善全身麻醉后血流动力学紊乱的作用，有利于患者术后恢复。
목적：탐토축단구강합면외과전신마취수술환자마취청성후진식적시간，감경환자불괄화불량반응，촉진환자술후회복。방법장2014년4~9월전신마취수술적160례구강합면외과환자，안수궤수자표법분성대조조여관찰조각80례，대조조준의촉급여전신마취청성후6 h진류질음식，관찰조급여전신마취청성후2h진수，4h진류질음식，관찰2조환자오흡、찬전외주혈당치、혈압화심솔급환자구갈、기아、악심、구토등불괄발생솔。결과관찰조구갈、기아、악심、구토불괄발생솔현저저우대조조（4례비73례、15례비76례、10례비29례、1례비7례），P＜0.05，χ2치분별위119.19、94.83、12.24、4.74；관찰조찬전외주혈당치고우대조조[（4.82±0.74）mmol/L비（4.06±0.62）mmol/L ]，P＜0.05，t=-7.04；2조오흡발생솔균위0；대조조술후혈압화심솔저우술전，P＜0.05，수축압、서장압화심솔적t치분별위：술후1 h-2.32、-2.03、-4.89；술후3 h-2.75、-10.54、-6.22；술후5 h-8.91、-14.76、-6.14；관찰조술후1 h측정혈압여술전비교차이무통계학의의，P＞0.05，수축압、서장압적t치분별위-2.73、-2.56。결론축단구강합면외과전신마취수술환자의식완전청성후진식시간，제전진수진식，가이완해환자불괄증상，피면저혈당，개선전신마취후혈류동역학문란적작용，유리우환자술후회복。
Objective To study shorten the time of initial oral intake and fluid intake after general anesthesia in patients receiving oral and maxillofacial surgery,and to reduce the patient′s discomfort and adverse reactions and promote the postoperative recovery. Methods A total of 160 patients were divided into control group and observation group with 80 cases each by random digits table method from April to September in 2014. Patients in control group were allowed to take food orally 6 h after they emerged from anesthesia; while those in observation group were allowed to drink water after 2 h at emergence from anesthesia and take liquid food after 4 h. The mis-aspiration,the fasting glucose,blood pressure,heart rate and the rate of thirst,hunger,nausea,vomiting were observed. Results The rate of thirst, hunger, nausea, vomiting in observation group were significantly lower than those in control group(4 cases vs. 73 cases, 15 cases vs. 76 cases, 10 cases vs. 29 cases, 1 case vs. 7 cases), and there were significant differences, P<0.05, χ2=119.19, 94.83, 12.24, 4.74.The fasting plasma glucose level in observation group was higher than that in control group:(4.82 ±0.74) mmol/L vs. (4.06 ±0.62) mmol/L, and there was significant difference, P<0.05, t=-7.04. The incidence of mis-aspiration was 0 in two groups. The blood pressure and heart rate in control group after operation were lower than those before operation, P<0.05,the t value of systolic pressure, diastolic blood pressure and heart rate:-2.32,-2.03,-4.89 after operation of 1 h,-2.75,-10.54,-6.22 after operation of 3 h,-8.91,-14.76,-6.14 after operation of 5 h. There was no significant difference in blood pressure after operation of 1 h compared with that before operation in observation group, P>0.05, the t value of systolic blood pressure, diastolic blood pressure were-2.73,-2.56. Conclusion Shorten the time of taking food for patients undergoing the oral and maxillofacial surgery,in order to relieve uncomfortable symptoms,prevent hypoglycemia and the hemodynamic disturbance after anesthesia, and promote recovery,early postoperative feeding should be suggested on the premise that they are fully awake.