胃超声评估术前碳水化合物饮料胃排空情况:一项随机对照非劣效性研究

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胃超声评估术前碳水化合物饮料胃排空情况:一项随机对照非劣效性研究

贵州医科大学麻醉与心脏电生理课题组  

翻译：潘志军编辑：陈锐 审校：曹莹

背景  

评估胃排空的工具日益发展。本研究的目的是通过证明NO-NPO组的胃窦横截面积(CSA)等于或小于NPO(禁食禁饮)组，来证明碳水化合物饮料不会增加肺误吸的风险。

方法  

本研究纳入了64名拟在腹腔镜下行择期良性妇科手术的患者，并随机分配到NPO组（n=32）或NO-NPO组（n=32）。正常饮食至术前午夜即开始禁食，NPO组一直禁食到手术开始，而NO-NPO组在午夜时选择摄入400mL的碳水化合物饮料，并且在麻醉前2小时之前自由饮用。主要观察结果是通过胃超声测量的患者右侧卧位（RLDP）胃窦CSA。非劣效性定义为CSA<2.8cm2的平均差。次要观察结果包括仰卧位CSA、胃容积(GV)、单位重量的GV(GV/kg)、GV/kg >1.5mL/kg和Perlas级。

结果  

RLDP时的CSA在NPO组(6.25±3.79cm2)和NO-NPO组(6.21±2.48cm2)之间无显著性差异；P=0.959)。RLDP (NO-NPO组—NPO组) CSA的平均差为0.04, 95%[CI]：−1.56～1.64)，且在2.8 cm2的非劣势范围内。两组间CSA无差异(NPO组为4.17±2.34 cm2, NO-NPO组为4.28±1.23cm2；P=0.828)。NPO组GV(70±56 mL)与NO-NPO组(66±36 mL；平均差，3.66；95% CI：20-27，P=0.756) 无明显差异。NPO组GV/kg(1.25±1.00mL/kg)与NO-NPO组GV/kg(1.17±0.67 mL/kg；P=0.694)无显著差异。Perlas分级的中位数(四分位数范围)在NPO组为1 (0-1)，在NO-NPO组为0.5 (0-1) (P=0.871)。

结论

根据胃超声评估，与午夜禁食相比，麻醉前2小时摄入碳水化合物饮料不会延迟胃排空。

原始文献来源  

Eun-Ah Cho, Jin Huh , Sung Hyun Lee, et al. Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study[J]. (Anesth Analg 2021 Jan 15).

Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study

Abstract

Background: Tools for the evaluation of gastric emptying have evolved over time. The purpose of this study was to show that the risk of pulmonary aspiration is not increased with carbohydrate drink, by demonstrating that the gastric antral cross-sectional area (CSA) of the NO-NPO group is either equivalent to or less than that of the NPO (nil per os) group.

Methods: Sixty-four patients scheduled for elective laparoscopic benign gynecologic surgery were enrolled and randomly assigned to the NPO group (n=32) or the NO-NPO group (n=32). After having a regular meal until midnight before surgery, the NPO group fasted until surgery, while the NO-NPO group ingested 400 mL of a carbohydrate drink at midnight and freely up to 2 hours before anesthesia. The primary outcome was the gastric antral CSA by gastric ultrasound in right lateral decubitus position (RLDP). Noninferiority was defined as a mean difference of CSA <2.8 cm2. Secondary outcomes included CSA in supine position, gastric volume (GV), GV per weight (GV/kg), GV/kg >1.5 mL/kg, and Perlas grade.

Results: CSA in RLDP was not different between the NPO group (6.25±3.79 cm2) and the NO-NPO group (6.21±2.48 cm2; P=0.959). The mean difference of CSA in RLDP (NO-NPO group − NPO group) was 0.04 (95% confidence interval [CI], −1.56 to 1.64), which was within the noninferiority margin of 2.8 cm2. CSA was not different between the 2 groups (4.17±2.34 cm2 in NPO group versus 4.28±1.23 cm2 in NO-NPO group; P=0.828). GV in NPO group (70±56 mL) was not different from NO-NPO group (66±36 mL; mean difference, 3.66; 95% CI,

−20 to 27; P=0.756). GV/kg in the NPO group (1.25±1.00 mL/kg) was not different from the NO-NPO group (1.17±0.67 mL/kg; P=0.694). The incidence of GV/kg > 1.5 mL/kg was not different between NPO (31.3%) and NO-NPO group (21.9%; P=0.768). The median (interquartile range) of the Perlas grade was 1 (0–1) in NPO group and 0.5 (0–1) in NO-NPO group (P=0.871).

Conclusions: Preoperative carbohydrates ingested up to 2 hours before anesthesia do

not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound.