协和医学杂志

2019, v.10(06) 589-593

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术前2h饮用碳水化合物对老年胃肠道手术患者胃容量及反流误吸风险的影响:前瞻性随机对照研究
Effects of Carbohydrate Consumption Two Hours before Operation on the Gastric Volume and the Risk of Reflux Misabsorption in Elderly Patients with Gastrointestinal Surgery:A Prospective Randomized Controlled Study

刘霞;翟文虎;陈盼盼;许婷;范丹;魏新川;
LIU Xia;ZHAI Wen-hu;CHEN Pan-pan;XU Ting;FAN Dan;WEI Xin-chuan;Department of Anesthesiology,North Sichuan Medical College;Department of Anesthesiology,The Sichuan Provincial Academy of Medical Sciences & Sichuan Provincial People's Hospital;

摘要(Abstract):

目的应用床旁超声技术观察术前2 h饮用碳水化合物对老年胃肠道手术患者麻醉前胃容量的影响,并评估患者发生反流误吸的风险。方法前瞻性选取2017年12月至2018年10月,在四川省人民医院行胃肠道手术的老年患者(>65岁),随机分为试验组和对照组。试验组常规禁食8 h,术前2 h口服200 ml碳水化合物;对照组要求术前禁食8 h,禁饮4 h。麻醉前采用床旁超声技术测量45°半坐位及右侧卧位胃窦部头尾径及前后径,分别计算两种体位下的胃窦部横截面积(cross-sectional area,CSA)、胃容量(gastric volume,GV)及胃容量与体重比(GV/weight,GV/W)。采用GV超声半定量3分评估法及GV/W分级法评估患者发生反流误吸的风险。结果共纳入69例符合入选和排除标准的患者,其中试验组33例,对照组36例。两组基线资料、手术类别及美国麻醉医师学会分级无统计学差异(P均>0. 05)。半坐位下,试验组和对照组的GV/W分别为(0. 57±0. 23) ml/kg和(0. 44±0. 21) ml/kg;右侧卧位下,试验组和对照组的CSA分别为(578. 8±71. 5) mm2和(513. 3±53. 2) mm2,GV分别为(21. 2±11. 1) ml和(12. 9±6. 8) ml,GV/W分别为(0. 36±0. 17) ml/kg和(0. 20±0. 11) ml/kg,上述指标两组间均存在统计学差异(P均<0. 05)。GV超声半定量评分:试验组0分17例(51. 5%,17/33),1分15例(45. 5%,15/33),2分1例(3. 0%,1/33),对照组0分25例(69. 4%,25/36),1分11例(30. 6%,11/36),2分0例(0,0/33),两组评分构成比无统计学差异(P>0. 05)。反流误吸风险评估:试验组极低风险者占比81. 8%(27/33)、低风险18. 2%(6/33)、高风险0 (0/33),对照组极低风险者占比94. 4%(34/36)、低风险5. 6%(2/36)、高风险0 (0/33),两组间构成比亦无统计学差异(P>0. 05)。结论老年胃肠道手术患者术前2 h饮用200 ml碳水化合物虽可以增加麻醉前胃容量,但并不增加反流误吸的风险。
Objective The aim of this study was to observe the effect of carbohydrate consumption 2hours before surgery on the gastric volume of elderly patients undergoing gastrointestinal surgery with the technique of point-of-care gastric ultrasound,and further assess the risk of reflux misabsorption. Methods Elderly patients( > 65 years) undergoing abdominal operation were prospectively recruited in Sichuan Provincial People's Hospital between December 2017 and October 2018 and were randomly divided into experimental and control groups. The patients in the experimental group fasted for 8 hours and drank 200 ml carbohydrate 2 hours before surgery; those in the control group were required of 8-hour food fasting and 4-hour liquid fasting before the operation. The gastric antrum of each patient was scanned in the position of 45° semi-sitting and right lateral decubitus. The anterior-posterior diameter and cranial-caudal diameter of the gastric antrum were measured at the above two positions before induction of anesthesia. Then the distal cross-sectional area( CSA),gastric volume( GV),and gastric volume/weight( GV/W) were calculated. Correlation of the semi-quantitative GV score and GV/W grading with the risk of reflux misaspiration were assessed. Results A total of 69 patients meeting the inclusive and exclusive criteria were enrolled in this study,33 in the experimental group and 36 in the control group. The two groups showed similar demographic characteristics,surgical category,and classification of the American Society of Anesthesiologists( all P>0. 05). In the semi-sitting position,the GV/W was( 0. 57±0. 23) ml/kg and( 0. 44±0. 21) ml/kg in the experimental and the control groups,respectively; in the right lateral decubitus position,CSA was( 578. 8 ± 71. 5) mm2 in the experimental group vs.( 513. 3 ±53. 2) mm2 in the control group,GV( 21. 2±11. 1) ml vs.( 12. 9±6. 8) ml,GV/W( 0. 36±0. 17) ml/kg vs.( 0. 20±0. 11) ml/kg,respectively; the above all showed statistically significant between the two groups( all P<0. 05). The semi-quantitative GV score showed 0 in 17 patients( 51. 5%,17/33),1 in 15( 45. 5%,15/33),2 in 1( 3. 0%,1/33) in the experimental group and 0 in 25( 69. 4%,25/36),1 in 11( 30. 6%,11/36),2 in 0( 0,0/33) in the control group( P > 0. 05). The risk assessment of reflux misabsorption showed that very low risk was 81. 8%( 27/33) in the experimental group vs. 94. 4%( 34/36) in the control group,low risk 18. 2%( 6/33) vs. 5. 6%( 2/36),and no high risk in both groups( P>0. 05). Conclusion Although preoperative carbohydrate consumption might increase the GV in elderly patients with gastrointestinal surgery,the risk of reflux misabsorption does not increase.

关键词(KeyWords): 老年;胃肠道手术;胃容量;碳水化合物;床旁胃超声
elderly;gastrointestinal surgery;gastric volume;carbohydrate;point-of-care gastric ultrasound

Abstract:

Keywords:

基金项目(Foundation): 四川省科技厅基金资助项目(2017FZ0042)

作者(Author): 刘霞;翟文虎;陈盼盼;许婷;范丹;魏新川;
LIU Xia;ZHAI Wen-hu;CHEN Pan-pan;XU Ting;FAN Dan;WEI Xin-chuan;Department of Anesthesiology,North Sichuan Medical College;Department of Anesthesiology,The Sichuan Provincial Academy of Medical Sciences & Sichuan Provincial People's Hospital;

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