Wei Yue, Lu Xi, Zhang Jing, Liu Kun Peng, Wang Yong Jun, Yao Lan
Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China.
Department of Gynecology, Peking University International Hospital, Beijing 102206, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Oct 18;55(5):893-898. doi: 10.19723/j.issn.1671-167X.2023.05.018.
To investigate the effect of 300 mL carbohydrates intake two hours before sur-gery on the gastric volume (GV) in patients positioning in trendelenburg undergoing gynecological laparoscopic procedures by using gastric antrum sonography, and further assess the risk of reflux aspiration.
From June 2020 to February 2021, a total of 80 patients, aged 18-65 years, body mass index (BMI) 18-35 kg/m, falling into American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, scheduled for gynecological laparoscopic procedures positioning in trendelenburg were recruited and divided into two groups: the observation group ( =40) and the control group (=40). In the observation group, solid food was restricted after 24:00, the patients were required to take 300 mL carbohydrates two hours before surgery. In the control group, solid food and liquid intake were restricted after 24:00 the night before surgery. The cross-sectional area (CSA) of gastric antrum was measured in supine position and right lateral decubitus position before anesthesia. Primary outcome was gastric volume (GV) in each group. Secondary outcome included Perlas A semi-quantitative grading and gastric volume/weight (GV/W). All the patients received assessment of preoperative feeling of thirsty and hunger with visual analogue scale (VAS).
Complete data were available in eighty patients. GV was (58.8±23.6) mL in the intervention group . (56.3±22.1) mL in the control group, GV/W was (0.97±0.39) mL/kg . (0.95±0.35) mL/kg, respectively; all the above showed no significant difference between the two groups ( > 0.05). Perlas A semi-quantitative grading showed 0 in 24 patients (60%), 1 in 15 patients (37.5%), 2 in 1 patient (2.5%) in the intervention group and 0 in 25 (62.5%), 1 in 13 (32.5%), 2 in 2 (5%) in the control group, the proportion of Perlas A semi-quantitative grading showed no significant difference between the two groups ( > 0.05). A total of 3 patients (1 in the intervention group and 2 in the control group) with Perlas A semi-quantitative grading 2 were treated with special intervention, no aspiration case was observed in this study. The observation group endured less thirst and hunger (＜0.05).
Three hundred mL carbohydrates intake two hours before surgery along with ultrasound guided gastric content monitoring does not increase gastric volume and the risk of reflux aspiration in patients positioning in trendelenburg undergoing gynecological laparoscopic surgery, and is helpful in minimizing disturbance to the patient's physiological needs, therefore leading to better clinical outcome.
采用胃窦超声检查，探讨术前2小时摄入300 mL碳水化合物对妇科腹腔镜手术中处于头低脚高位患者胃容量（GV）的影响，并进一步评估反流误吸的风险。
选取2020年6月至2021年2月计划行妇科腹腔镜手术且处于头低脚高位的80例患者，年龄18 - 65岁，体重指数（BMI）18 - 35 kg/m²，美国麻醉医师协会（ASA）身体状况分级为Ⅰ或Ⅱ级，将其分为两组：观察组（n = 40）和对照组（n = 40）。观察组于24:00后禁食固体食物，要求患者在手术前2小时摄入300 mL碳水化合物。对照组于手术前一晚24:00后禁食固体食物和限制液体摄入。麻醉前在仰卧位和右侧卧位测量胃窦横截面积（CSA）。主要观察指标为每组的胃容量（GV）。次要观察指标包括Perlas A半定量分级和胃容量/体重（GV/W）。所有患者采用视觉模拟评分法（VAS）评估术前口渴和饥饿感。
80例患者均获得完整数据。干预组GV为（58.8±23.6）mL，对照组为（56.3±22.1）mL；GV/W分别为（0.97±0.39）mL/kg和（0.95±0.35）mL/kg；以上各项两组间比较差异均无统计学意义（P > 0.05）。Perlas A半定量分级显示，干预组24例（60%）为0级，15例（37.5%）为1级，1例（2.5%）为2级；对照组25例（62.5%）为0级，13例（32.5%）为1级，2例（5%）为2级，两组Perlas A半定量分级比例比较差异无统计学意义（P > 0.05）。Perlas A半定量分级为2级的患者共3例（干预组1例，对照组2例）接受了特殊干预，本研究未观察到误吸病例。观察组口渴和饥饿感较轻（P＜0.05）。
术前2小时摄入300 mL碳水化合物并结合超声引导下胃内容物监测，不会增加妇科腹腔镜手术中处于头低脚高位患者的胃容量和反流误吸风险，且有助于减少对患者生理需求的干扰，从而获得更好临床效果。
