Hellström Per M, Samuelsson Bodil, Al-Ani Amer N, Hedström Margareta
Department of Medical Sciences, Uppsala University, SE-75185, Uppsala, Sweden.
Department of Clinical Sciences, Division of Orthopedics, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
BMC Anesthesiol. 2017 Feb 15;17(1):23. doi: 10.1186/s12871-016-0299-6.
Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture.
In a prospective study gastric emptying of 400 ml 12.6% carbohydrate rich drink was investigated in nine elderly women, age 77-97, with acute hip fracture. The emptying time was assessed by the paracetamol absorption technique, and lag phase and gastric half-emptying time was compared with two gender-matched reference groups: ten elective hip replacement patients, age 45-71 and ten healthy volunteers, age 28-55.
The mean gastric half-emptying time in the elderly study group was 53 ± 5 (39-82) minutes with an expected gastric emptying profile. The reference groups had a mean half-emptying time of 58 ± 4 (41-106) and 59 ± 5 (33-72) minutes, indicating normal gastric emptying time in elderly with hip fracture.
This pilot study in women with an acute hip fracture shows no evidence of delayed gastric emptying after an orally taken carbohydrate-rich beverage during the pre-operative fasting period. This implies no increased risk of pulmonary aspiration in these patients. Therefore, we advocate oral pre-operative management with carbohydrate-rich beverage in order to mitigate fasting-induced additive stress in the elderly with hip fracture.
ClinicalTrials.gov NCT02753010 . Registered 17 April 2016, retrospectively.
老年急性髋部骨折患者的禁食指南与其他创伤患者相同，且比择期手术患者的禁食时间更长。原因是假定应激导致胃排空延迟，可能存在肺误吸风险。老年患者长时间禁食可能会产生严重的负面代谢后果。我们研究的目的是调查因急性髋部骨折计划手术的老年女性术前胃排空是否延迟。
在一项前瞻性研究中，对9名年龄在77 - 97岁的老年急性髋部骨折女性患者进行了400毫升12.6%富含碳水化合物饮料的胃排空研究。通过对乙酰氨基酚吸收技术评估排空时间，并将延迟期和胃半排空时间与两个性别匹配的对照组进行比较：10名年龄在45 - 71岁的择期髋关节置换患者和10名年龄在28 - 55岁的健康志愿者。
老年研究组的平均胃半排空时间为53±5（39 - 82）分钟，胃排空曲线正常。对照组的平均半排空时间分别为58±4（41 - 106）分钟和59±5（33 - 72）分钟，表明髋部骨折老年患者的胃排空时间正常。
这项针对急性髋部骨折女性患者的初步研究表明，术前禁食期间口服富含碳水化合物饮料后，没有证据表明胃排空延迟。这意味着这些患者发生肺误吸的风险没有增加。因此，我们提倡对髋部骨折老年患者进行术前口服富含碳水化合物饮料的管理，以减轻禁食引起的额外应激。
ClinicalTrials.gov NCT02753010。于2016年4月17日追溯注册。
