Reissell E, Taskinen M R, Orko R, Lindgren L
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Acta Anaesthesiol Scand. 1992 Oct;36(7):736-40. doi: 10.1111/j.1399-6576.1992.tb03555.x.
Gastroparesis is a frequently unrecognized complication of insulin-dependent diabetes mellitus, which subjects these patients to the risk of aspiration at induction of anaesthesia. The effect of oral cisapride on volume and pH of gastric contents was studied in 24 diabetic and 24 non-diabetic uraemic patients undergoing renal transplantation. All patients were allocated randomly in a double-blind fashion to receive either 10 mg of cisapride or placebo orally approximately 100 min before anaesthesia and three times daily for the first 2 postoperative days. After the induction of anaesthesia, gastric contents were aspirated through a nasogastric tube, and the pH and volume were measured. The emptiness of the stomach was verified by gastroscopy. Gastric volumes exceeding 0.4 ml.kg-1 were observed in 12/24 of the diabetic and 4/24 of the non-diabetic uraemic patients (P < 0.01). The pH of the gastric contents did not differ between the groups, ranging from 1-8 in diabetics and 1-7 in non-diabetics. Cisapride lacked effect on gastric contents and postoperative gastrointestinal motility. Diabetic uraemic patients had larger gastric volumes than their non-diabetic controls at induction of anaesthesia. Cisapride had no effect on gastric emptying preoperatively nor on postoperative bowel function.
胃轻瘫是胰岛素依赖型糖尿病常见的未被认识的并发症，这使这些患者在麻醉诱导时面临误吸风险。在24例接受肾移植的糖尿病尿毒症患者和24例非糖尿病尿毒症患者中，研究了口服西沙必利对胃内容物体积和pH值的影响。所有患者均以双盲方式随机分配，在麻醉前约100分钟口服10毫克西沙必利或安慰剂，术后头2天每天3次。麻醉诱导后，通过鼻胃管抽吸胃内容物，并测量pH值和体积。通过胃镜检查证实胃排空情况。糖尿病尿毒症患者中有12/24例、非糖尿病尿毒症患者中有4/24例观察到胃体积超过0.4 ml·kg-1（P<0.01）。两组胃内容物的pH值无差异，糖尿病患者为1-8，非糖尿病患者为1-7。西沙必利对胃内容物和术后胃肠蠕动无影响。在麻醉诱导时，糖尿病尿毒症患者的胃体积比非糖尿病对照者大。西沙必利术前对胃排空无影响，术后对肠功能也无影响。
