胃超声检查评估剖宫产产妇术前饮用碳水化合物后胃排空的效果  

Evaluation of gastric emptying after drinking carbohydrates before cesarean section by gastric ultrasonography

作　　者：魏越 姚兰 陆希[1] 王军 蔺莉[2] 刘鲲鹏 WEI Yue;YAO Lan;LU Xi;WANG Jun;LIN Li;LIU Kun-peng(Department of Anesthesiology,Peking University International Hospital,Beijing 102206,China;Department of Obstetrics and Gynecology,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院麻醉科,北京102206 [2]北京大学国际医院妇产科,北京102206

出　　处：《北京大学学报（医学版）》2023年第6期1082-1087,共6页Journal of Peking University:Health Sciences

摘　　要：目的:探讨胃窦部超声检查评估剖宫产产妇术前2 h口服300 mL碳水化合物后胃排空的效果,并分析影响产妇胃排空的风险因素。方法:选择2020年8月至2021年2月在北京大学国际医院行择期剖宫产的产妇80例,年龄22~43岁,体重指数(body mass index,BMI)<35 kg/m^(2),孕周≥36周,美国麻醉医师学会(American Society of Anesthesiologists,ASA)分级Ⅰ或Ⅱ级,随机分为干预组和对照组,每组40例。干预组产妇于术前一日22:00后禁食,术日在预期手术开始前2 h口服碳水化合物300 mL;对照组产妇于术前一日22:00后禁食禁饮。两组患者入手术室后行术前干渴感及饥饿感的视觉模拟评分(visual analogue scale,VAS)。麻醉前行胃窦部超声检查,分别在半坐位和右侧卧位下测量胃窦横截面积(cross-sectional area,CSA),并进一步计算两组患者胃容量(gastric volume,GV)及胃容量/体质量(gastric volume/weight,GV/W),并进行Perlas A半定量评级。记录患者入室(T0)、麻醉后5 min(T1)、胎儿剖出即刻(T2)、手术结束(T3)时的血压和心率。记录术中、术后24 h恶心呕吐的发生情况。结果:两组各有1例患者无法清晰显示胃窦部,余78例患者可以进行CSA测量及Perlas A半定量评级。半坐位下,干预组和对照组的CSA分别为(5.07±1.73)cm^(2)和(5.24±1.96)cm^(2);右侧卧位下,干预组和对照组的CSA分别为(7.32±2.17)cm^(2)和(7.25±2.24)cm^(2),GV分别为(91.74±32.34)mL和(90.07±31.68)mL,GV/W分别为(1.27±0.40)mL/kg和(1.22±0.41)mL/kg,上述指标两组间差异均无统计学意义(P>0.05)。Perlas A半定量评级:干预组0级20例(51.3%),1级16例(41%),2级3例(7.7%);对照组0级22例(56.4%),1级15例(38.5%),2级2例(5.1%),两组评级构成比差异无统计学意义(P>0.05)。Perlas A半定量评级为2级的患者(干预组3例及对照组2例),麻醉前静脉注射甲氧氯普胺0.2 mg/kg,均未发生反流误吸。与对照组比较,干预组术前干渴感、饥饿感VAS明显降低(P<0.05)。术Objective:To investigate the effect of gastric antrum ultrasonography in evaluating gastric emptying after oral administration of 300 mL carbohydrates two hours before cesarean section,and to analyze the risk factors of gastric emptying in pregnant women.Methods:From August 2020 to February 2021,a total of 80 patients,aged 22-43 years,body mass index(BMI)<35 kg/m^(2),gestational age≥36 weeks,falling into American Society of Anesthesiologists(ASA)physical statusⅠorⅡ,scheduled for cesarean sections in Peking University International Hospital were recruited and divided into two groups:the intervention group(n=40)and the control group(n=40).In the intervention group,solid food was restricted after 22:00,the patients were required to take 300 mL carbohydrates two hours before cesarean section.In the control group,solid food and liquid intake were restricted after 22:00 the night before surgery.All the patients received assessment of preoperative feeling of thirst and starvation with visual analogue scale(VAS).The cross-sectional area(CSA)of gastric antrum was measured in supine position and right supine position before anesthesia,the gastric volume(GV)and the gastric volume/weight(GV/W)of the two groups was further calculated.Perlas A semi-quantitative grading assessments were performed in each patient.The blood pressure and heart rate were recorded at admission(T0),5 minutes after anesthesia(T1),immediately after fetal delivery(T2)and at the end of the surgery(T3).The occurrence of nausea and vomiting during the operation and 24 hours after the operation were recorded.Results:One case in each group was excluded because the antrum was not clearly identified during the ultrasound assessments.In the semi-sitting position,the CSA was(5.07±1.73)cm^(2)in the intervention group vs.(5.24±1.96)cm^(2)in the control group,respectively;in the right lateral decubitus position,CSA was(7.32±2.17)cm^(2)in the intervention group vs.(7.25±2.24)cm^(2)in the control group,GV was(91.74±32.34)mL vs.(90.07±31.68)mL,GV/W was(1.2

关 键 词：胃窦部超声 胃窦部横截面积 胃容量 孕产妇 

分 类 号：R614.3[医药卫生—麻醉学]