术前饮用碳水化合物饮料对老年胸科手术病人麻醉诱导前胃容量及围术期低血压的影响  

Effect of drinking carbohydrate beverage before anesthesia on gastric volume and perioperative hypotension in elderly patients undergoing thoracic surgery

作　　者：周理 齐晓轩 韩艳芳 王伟扬 刘再英 王琨 ZHOU Li;QI Xiao-xuan;HAN Yan-fang;WANG Wei-yang;LIU Zai-ying;WANG Kun(the First Clinical Medical College,Mudanjiang Medical University,Mudanjiang 157000,China;Department of Thoracic Surgery,Hongqi Hospital Affiliated to Mudanjiang Medical University,Mudanjiang 157000,China;Department of Anesthesiology,Hongqi Hospital Affiliated to Mudanjiang Medical University,Mudanjiang 157000,China)

机构地区：[1]牡丹江医学院第一临床医学院,黑龙江省牡丹江市157000 [2]牡丹江医学院附属红旗医院胸外科,黑龙江省牡丹江市157000 [3]牡丹江医学院附属红旗医院麻醉科,黑龙江省牡丹江市157000

出　　处：《实用老年医学》2023年第7期671-675,共5页Practical Geriatrics

基　　金：牡丹江医学院研究生导师科研专项计划(YJSZX2022101)。

摘　　要：目的 探讨术前2 h饮用碳水化合物饮料对老年胸科手术病人麻醉诱导前胃容量及围术期低血压的影响。方法 选择择期行胸腔镜下肺叶切除术的老年病人60例,随机分为2组,每组30例。对照组术前常规禁食,试验组在麻醉诱导前2 h饮用5%葡萄糖水4 mL/kg,入室后采用超声检查2组病人的胃窦部,测量半卧位下胃窦部横截面积(cross-sectional area,CSA),计算胃容量(gastric volume,GV)、胃容量与体质量的比值(GV/W),评估2组病人反流误吸风险。行桡动脉有创动脉血压监测,记录T1(入室后5 min)、T2(麻醉诱导后3 min)、T3(手术开始时)、T4(手术进行1 h)、T5(手术结束时)、T6(术后2 h)及T7(术后6 h)的SBP、平均动脉压(MAP)及心率(HR),比较2组病人围术期SBP降幅>20%超过30 s的发生率,记录2组病人围术期麻黄碱和去甲肾上腺素的使用率、使用量及病人的术后情况。结果 2组病人麻醉诱导前半卧位下CSA、GV及反流误吸风险差异无统计学意义(P>0.05);试验组在T2和T5时刻的MAP高于对照组(P<0.05),对照组围术期SBP降幅>20%超过30 s的发生率为75.86%,高于试验组的44.83%(P<0.05);试验组麻黄碱和去甲肾上腺素的使用率和使用量均明显低于对照组(P<0.05);试验组术后首次排气时间短于对照组(P<0.05),术后24 h内恶心呕吐的发生率低于对照组(P<0.05)。结论 术前2 h饮用4 mL/kg的碳水化合物饮料不会增加返流误吸风险,还能更好地维持老年胸科手术病人围术期血压的稳定,促进病人术后快速康复。Objective To investigate the effects of drinking carbohydrate beverage 2 hours before surgery on gastric volume before anesthesia induction and perioperative hypotension in the elderly patients undergoing thoracic surgery.Methods Sixty elderly patients undergoing thoracoscopic lobectomy were randomly divided into two groups,with 30 patients in each group.Control group kept routine fasting before surgery,and experimental group received 5% glucose water 4 mL/kg 2 hours before anesthesia induction.Ultrasonography was performed in both groups after sectional examination,and cross-sectional area(CSA) under semi-recessed position was measured.Gastric volume(GV) and the ratio of gastric volume to body weight(GV/W) were calculated to evaluate the risk of reflux aspiration in the two groups.The systolic blood pressure(SBP),mean arterial pressure(MAP) and heart rate(HR) at T1(5 min after entry),T2(3 min after induction of anesthesia),T3(at the beginning of operation),T4(1 h after operation),T5(at the end of operation),T6(2 h after operation) and T7(6 h after operation) were detected by radial invasive arterial BP monitoring.The incidence rate of a perioperative SBP reduction 20% for over 30 s,the dosage and the usage rate of ephedrine and norepinephrine in the perioperative period and the postoperative conditions of the patients were recorded and compared between the two groups.Results There were no significant differences in the risk of reflux aspiration,CSA and GV between the two groups(P<0.05).The levels of MAP at T2 and T5 were higher in experimental group than those in control group(P<0.05).The incidence rate of perioperative SBP reduction in control group was 75.86%,compared with 44.83% in experimental group( P<0.05).The utilization rate and dosage of ephedrine and norepinephrine in experimental group were significantly lower than those in control group(P<0.05);Compared with control group,the first postoperative exhaust time was significantly shorter and the incidence rate of nausea and vomiting within 24 hours after

关 键 词：碳水化合物 老年人 胃容量 血容量 低血压 

分 类 号：R614[医药卫生—麻醉学]