【罂粟摘要】高剂量与低剂量硬膜外芬太尼对未禁食产妇胃排空影响的比较：一项随机双盲对照试验

2021-12-17 09:35

高剂量与低剂量硬膜外芬太尼对未禁食产妇胃排空影响的比较：一项随机双盲对照试验

贵州医科大学麻醉与心脏电生理课题组

翻译：佟睿编辑：陈锐审校：曹莹

背景

使用扑热息痛吸收试验显示，硬膜外芬太尼剂量在100μg以上，可以减少禁食分娩妇女的胃排空。

目的

旨在于应用胃超声检查探讨芬太尼剂量对未禁食分娩妇女胃排空的影响。

试验设计

一项随机双盲对照研究。

范围设置

2020年7月30日至10月11日在以色列特拉维夫的一家三级医疗中心接受治疗的患者。

受试人群

研究纳入80名宫颈扩张小于或等于5cm，年龄至少18岁，妊娠至少37周，单胎妊娠及头胎的分娩妇女。

干预因素

随机分为硬膜外高(>100 μg)或低(<100 μg)芬太尼累积用量两组，对各组产妇进行超声胃内容物评估，测量硬膜外放置时和放置后2小时(T2h)的胃窦横截面积(CSA)。

主要观察指标

主要观察指标是比较高剂量和低剂量芬太尼组产妇T2h的CSA。次要观察指标包括基线和T2h内CSA的变化。亚组分析根据基线胃内容物、胃排空(CSA<381mm2)或饱胃(CSA≥381mm2)比较高剂量和低剂量芬太尼组产妇T2h胃内容物的差别。

结果

对80名女性的数据进行了分析，63名女性在基线时是空腹的，17名女性是饱腹的。高剂量组与低剂量芬太尼组在T2h时CSA无显著差异，均数±标准差335±133mm2 vs低剂量芬太尼组均数±标准差335±172mm2，P=0.991。基线至T2h时CSA改变量为，高剂量组46±149mm2，低剂量组为49±163mm2。根据基线胃内容物进行的亚组分析显示，在T2h的CSA无统计学差异。HOLIDAY

结论

在我们的非禁食分娩队列中，通过超声测量发现接受高剂量和低剂量硬膜外芬太尼的妇女在T2h的CSA是相似的。

原始文献来源

Elisheva Fiszer, Boris Aptekman, Yuval Baar, et al. The effect of high-dose versus low-dose epidural fentanyl on gastric emptying in nonfasted parturients: A double-blinded randomised controlled trial.[J].Eur J Anaesthesiol 2022;39:50–57.

The effect of high-dose versus low-dose epidural fentanyl on gastric emptying in nonfasted parturients: A double-blinded randomised controlled trial

Abstract

BACKGROUND Epidural fentanyl doses above 100μg have been shown, using the paracetamol absorption test, to reduce gastric emptying in fasted labouring women.

OBJECTIVE ：To investigate the effect of fentanyl dose on gastric emptying in nonfasted labouring women using gastric ultrasonography.

DESIGN ：A double-blinded randomised controlled study.

SETTING：A tertiary medical centre in Tel Aviv, Israel between 30 July 2020 and 11 October 2020.

PATIENTS：Eighty labouring women with cervical dilation 5cm or less, at least 18 years age, at least 37 weeks gestation with a singleton pregnancy and cephalad foetus.

INTERVENTIONS：Women randomised to high (>100μg) or low (<100μg) cumulative epidural fentanyl had ultrasound gastric content assessment, measuring antral cross-sectional area (CSA) at epidural placement and 2h thereafter (T2h).

MAIN OUTCOME MEASURES The primary outcome was CSA at T2h comparing high-dose versus low-dose fentanyl. Secondary outcomes included change in CSA between baseline and T2 h. Sub-group analysis compared stomach content at T2 h according to baseline stomach content, empty (CSA <381 mm2 ) or full (CSA ≥ 381 mm2 ), and high-dose versus low-dose fentanyl.

RESULTS Data from 80 women were analysed; 63 had empty and 17 had full stomach at baseline. There was no signifificant difference in CSA at T2h between high-dose, mean 335 ± SD 133 mm2 , versus low-dose fentanyl, mean 335 ± SD 172 mm2, P = 0.991. Change in CSA baseline to T2h was 46 ± SD 149 mm2 for high and 49 ± SD 163 mm2 for low-dose group, P = 0.931. The subgroup analysis according to baseline stomach content showed no statistically signifificant differences in CSA at T2h.

CONCLUSION ：The CSA at T2h was similar for women who received high-dose versus low-dose epidural fentanyl, measured by ultrasound, in our nonfasted labouring cohort.