超声评估择期手术前糖尿病和非糖尿病患者的胃内容物：一项前瞻性多中心研究。

Ultrasound assessment of the gastric content among diabetic and non-diabetic patients before elective surgery: a prospective multicenter study.

机构信息

Department of Anesthesiology and Perioperative Medicine, Tenon Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France -

Department of Anesthesiology, Foch Hospital, Suresnes, France -

出版信息

Minerva Anestesiol. 2022 Jan-Feb;88(1-2):23-31. doi: 10.23736/S0375-9393.21.15603-2.

DOI:10.23736/S0375-9393.21.15603-2

PMID:35224955

Abstract

BACKGROUND

Although diabetic gastroparesis could be responsible for delayed gastric emptying, there is conflicting evidence about the volume of gastric content in diabetic patients after preoperative fasting. We hypothesized that diabetic patients had an increased gastric content before anesthesia induction despite the following of fasting recommendations. We used ultrasound assessment of gastric content to evaluate this risk.

METHODS

This multicenter prospective single-blinded case-control study was conducted in three teaching University hospital in France. Our primary outcome was the comparison of increased gastric content between the two groups and was defined either by a Perlas grade 2 antrum or an antral cross-sectional area (CSA)>340 mm. Each diabetic patient was paired with three non-diabetic control patients. Forty-two diabetic and 126 control patients were included in the study.

RESULTS

Eighteen (42.9%) diabetic patients reached the primary outcome versus 28 (22.2%) in the control group (P=0.009). Diabetic patients presented less frequently with an empty stomach. Indeed, ten (23.8%) diabetic patients had a grade 0 antrum versus 71 (56.3%) in the control group (P<0.001). Twenty-four (70.6%) diabetic patients had an antral CSA<340 mm versus 98 (86%) in the control group (P=0.039). Overall, diabetic patients and increased gastric content were associated with an Odds Ratio, 2.63; 95% confidence interval, 1.25-5.52, P=0.009.

CONCLUSIONS

Our study documents that gastric content is increased among diabetic patients compared to control patients despite following appropriate fasting guidelines.

摘要

背景

尽管糖尿病性胃轻瘫可能导致胃排空延迟，但关于糖尿病患者术前禁食后胃内容物量仍存在矛盾证据。我们假设尽管遵循禁食建议，但糖尿病患者在麻醉诱导前胃内容物增加。我们使用超声评估胃内容物来评估这种风险。

方法

这是一项在法国三所教学医院进行的多中心前瞻性单盲病例对照研究。我们的主要结局是比较两组之间胃内容物增加的情况，定义为胃窦 Perlas 分级 2 或胃窦横截面积（CSA）>340mm。每个糖尿病患者与三个非糖尿病对照患者配对。共纳入 42 例糖尿病患者和 126 例对照患者。

结果

18 例（42.9%）糖尿病患者达到主要结局，而对照组为 28 例（22.2%）（P=0.009）。糖尿病患者胃排空的情况较少。实际上，10 例（23.8%）糖尿病患者胃窦为 0 级，而对照组为 71 例（56.3%）（P<0.001）。24 例（70.6%）糖尿病患者胃窦 CSA<340mm，而对照组为 98 例（86%）（P=0.039）。总体而言，糖尿病患者和胃内容物增加与比值比（OR）2.63相关；95%置信区间（CI）1.25-5.52，P=0.009。