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| 胃窦部超声检查用于评估快速康复术前禁食禁饮方案 |
| Evaluation of preoperative fasting protocol using gastric antrum sonography during enhanced recovery after surgery |
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| DOI：10.12089/jca.2018.11.009 |
| 中文关键词: 胃窦部超声 术前禁食禁饮 快速康复 |
| 英文关键词: Ultrasonography of the gastric antrum Preoperative fasting Enhanced recovery after surgery |
| 基金项目:上海市卫计委优秀学科带头人计划(2017BR042);上海交通大学高原高峰计划研究型医师项目(20172012);上海市级医院新兴前沿技术联合攻关项目(SHDC12016102) |
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| 中文摘要: |
目的 通过超声测量胃窦部截面积(cross-sectional area, CSA), 评估并探讨快速康复策略下的当日第一台择期手术患者适宜的术前禁食禁饮方案。
方法 纳入2017年6月至2018年3月当日行择期第1台手术患者120例, 男53例, 女67例, 年龄18～65岁, BMI 18～25 kg/m2, ASA Ⅰ或Ⅱ级。采用随机数字表法, 随机分为缩短禁饮时间组(S组)和常规禁饮时间组(C组), 每组60例。S组手术前晚20∶00后禁固体食物，20∶00—22∶00饮用碳水化合物饮品800 ml, 并于术日晨5∶30—6∶00摄入同类饮品400 ml, C组于手术前晚20∶00后禁固体食物，22∶00后常规禁饮。两组患者入手术室后行术前睡眠时间和质量评估, 口渴、饥饿评分, 8∶00行胃窦部超声检查, 进行Perlas A半定量评级, 测量胃窦截面积, 平卧位为CSA1, 右侧卧位为CSA2, 并进一步计算两组患者胃容量(gastric volume, GV), 单位体重右侧卧位截面积(CSA2/weight, CSA2/W), 以及单位体重胃容量(GV/weight, GV/W)。
结果 与C组比较, S组睡眠时间明显缩短(P<0.05), 口渴、饥饿评分明显降低(P<0.05), Perlas A半定量分级为2级的比例明显升高(P<0.05), CSA1、CSA2、GV、CSA2/W和GV/W明显增大(P<0.05)。两组共7例半定量评级为2级的患者, 均人为干预, 无一例显性反流误吸发生。
结论 患者手术前晚入睡前和术前2 h饮少量低浓度含糖液或水，同时加强胃容量监测，可以减少对患者生理需求的干扰，临床效果更好。 |
| 英文摘要: |
Objective To investigate the efficacy of preoperative fasting protocol on first-of-the-day elective surgery using gastric antrum sonography.
Methods A total of 120 patients, including 53 males, 67 females, aged 18 - 65 years, BMI 18 - 25 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, scheduled for first-of-the-day surgery were recruited and divided into two groups: shortened fasting group (group S, n = 60) and normal fasting group (group C, n = 60). In group S, solid food is restricted after 20∶00, patients are required to take 800ml carbonhydrate beverage at 20∶00 - 22∶00 and 400 ml beverage at 5∶30 - 6∶00 the morning of surgery. In group C, solid food is restricted after 20∶00, and liquid intake is restricted after 22∶00 the night before surgery. All patients received assessment of sleep duration and quality, preoperative feeling of thirsty and hunger, 8∶00 am ultrasound measurement of gastric antrum in supine (CSA1) and right lateral positions (CSA2) and were given semi-quantitative grading. Gastric volume, gastric volume/weight (GV/W), and cross-sectional area/weight, CSA2/W were evaluated.
Results Group S was endured less thirst and hunger, shorter sleep duration (P < 0.05), and larger CSA1 and CSA2 (P < 0.05). The grade of semi-quantitative, CSA1, CSA2 and GV/W, CSA2/W were significantly different between the two groups (P < 0.05). 7 cases were scored as semi-quantitative grading of Ⅱ and were treated. None aspiration case was observed.
Conclusion Small amount of low - sugar liquid intake the night before and 2 hours before surgery, along with ultrasound - guided astric content monitoring are helpful in minimizing disturbance to patients physiological needs, therefore leading to better clinical outcome. |
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