Stuart J C, Kan A F, Rowbottom S J, Yau G, Gin T
Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin.
Anaesthesia. 1996 May;51(5):415-21. doi: 10.1111/j.1365-2044.1996.tb07782.x.
Over a 3.5 year period, 384 patients requiring emergency Caesarean section under general anaesthesia received at random one of six acid aspiration prophylaxis regimens as soon as the decision was made for surgery. In the first phase of the study, sodium citrate administered orally 0.3 M, 30 ml (group C, n = 120) was compared with metoclopramide 10 mg administered intravenously and sodium citrate (group MC, n = 65). In the second phase, all patients received sodium citrate, and either intravenous administration of ranitidine 50 mg (group RC, n = 50), omeprazole 40 mg (group OC, n = 50), ranitidine 50 mg with metoclopramide 10 mg (group RMC, n = 50) or omeprazole 40 mg with metoclopramide 10 mg (group OMC, n = 49). Gastric contents were aspirated using a 16 FG Salem sump tube and acidity measured with a pH meter. Non-parametric tests were used for comparisons. There was no difference in gastric volume or pH between groups C and MC, or among OC, RC, OMC and RMC. After pooling the data, median (range) gastric volume in groups C and MC (55 (0-360) ml) was greater than in groups OMC and RMC (40 (3-270) ml, p < 0.05). Median (range) pH was lower in groups C and MC (4.97 (0.76-6.99)) than in groups OC, RC, OMC and RMC (5.76 (1.11-7.5), p < 0.001). The proportion of patients with pH < 3.5 and volume > 25 ml in the C and MC groups (43/185) was greater than that in the OC, RC, OMC and RMC groups (18/199, p < 0.001). Ranitidine and omeprazole administered intravenously were equally effective adjuncts to sodium citrate in reducing gastric acidity for emergency Caesarean section. Compared with sodium citrate alone, the addition of either ranitidine, omeprazole or metoclopramide alone did not reduce gastric volume while small reductions in gastric volume were seen with the addition of metoclopramide and either ranitidine or omeprazole.
在3.5年的时间里，384例需要在全身麻醉下进行急诊剖宫产的患者在决定手术时被随机分配接受六种酸误吸预防方案中的一种。在研究的第一阶段，将口服0.3M、30ml柠檬酸钠（C组，n = 120）与静脉注射10mg甲氧氯普胺和柠檬酸钠（MC组，n = 65）进行比较。在第二阶段，所有患者均接受柠檬酸钠，以及静脉注射50mg雷尼替丁（RC组，n = 50）、40mg奥美拉唑（OC组，n = 50）、50mg雷尼替丁与10mg甲氧氯普胺（RMC组，n = 50）或40mg奥美拉唑与10mg甲氧氯普胺（OMC组，n = 49）。使用16FG Salem吸引管抽吸胃内容物，并用pH计测量酸度。采用非参数检验进行比较。C组和MC组之间，以及OC组、RC组、OMC组和RMC组之间的胃容量或pH值没有差异。汇总数据后，C组和MC组的中位（范围）胃容量（55（0 - 360）ml）大于OMC组和RMC组（40（3 - 270）ml，p < 0.05）。C组和MC组的中位（范围）pH值（4.97（0.76 - 6.99））低于OC组、RC组、OMC组和RMC组（5.76（1.11 - 7.5），p < 0.001）。C组和MC组中pH < 3.5且容量 > 25ml的患者比例（43/185）高于OC组、RC组、OMC组和RMC组（18/199，p < 0.001）。静脉注射雷尼替丁和奥美拉唑作为柠檬酸钠的辅助药物，在降低急诊剖宫产患者胃酸度方面同样有效。与单独使用柠檬酸钠相比，单独添加雷尼替丁、奥美拉唑或甲氧氯普胺均未减少胃容量，而添加甲氧氯普胺与雷尼替丁或奥美拉唑一起时，胃容量有小幅减少。
