Maltby J Roger
University of Calgary, 12 Aspen Ridge Court SW, Calgary AB, Canada.
Best Pract Res Clin Anaesthesiol. 2006 Sep;20(3):363-78. doi: 10.1016/j.bpa.2006.02.001.
The purpose of this chapter is to review historical fasting guidelines and how the dogma of fasting from midnight arose and came to be challenged by randomized clinical trials of preoperative clear liquids versus overnight fast. Medical and anaesthesia textbooks and journals from the 19th and 20th centuries were consulted, and the results of clinical trials and the reaction to them are reviewed. The dogma appeared to result from extrapolation of pulmonary aspiration risk in 'full-stomach' emergency cases to healthy elective cases. This was reinforced when 25 mL in the stomach, present in half of all healthy fasting patients, was used as a surrogate marker for high risk of aspiration. Subsequent large-scale studies showed the risk to be minimal. Meta-analysis of randomized clinical trials demonstrated the safety of clear oral liquids until 2 hr preoperatively in healthy patients undergoing elective surgery. Reaction was cautious but led to eventual acceptance of evidence-based fasting guidelines.
本章旨在回顾历史上的禁食指南，以及午夜禁食这一教条是如何产生的，又是如何受到术前饮用清液与整夜禁食的随机临床试验的挑战。我们查阅了19世纪和20世纪的医学及麻醉学教科书和期刊，并对临床试验结果及其反应进行了回顾。这一教条似乎是将“饱腹”急诊病例中的肺误吸风险外推至健康择期手术病例而产生的。当将所有健康禁食患者中半数胃内存在的25毫升胃内容物用作误吸高风险的替代标志物时，这种情况得到了强化。随后的大规模研究表明风险极小。对随机临床试验的荟萃分析表明，对于接受择期手术的健康患者，术前2小时饮用清液是安全的。反应虽谨慎，但最终促成了基于证据的禁食指南被接受。
