肥胖女性术前口服碳水化合物后胃排空评估的非劣效性研究  

Evaluation of gastric emptying after preoperative oral carbohydrate administration in obese women:a non-inferiority study

作　　者：李雨虹 任志强 尹宁 LI Yuhong;REN Zhiqiang;YIN Ning(Department of Anesthesiology,Sir Run Run Hospital,Nanjing Medical University,Nanjing,Jiangsu 221000,China)

机构地区：[1]南京医科大学附属逸夫医院麻醉科,南京221000

出　　处：《重庆医学》2024年第4期587-591,共5页Chongqing medicine

摘　　要：目的研究肥胖女性术前口服碳水化合物2 h后的胃液量(GV)是否等于或小于常规禁饮者。方法选择择期在全身麻醉下行腹腔镜妇科手术的肥胖患者作为研究对象,BMI 28~32 kg/m^(2),美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,年龄18~65岁。采用随机数字表法将患者分为碳水组(CHO组)和禁食组(Control组),每组51例。Control组术前1 d的23:00开始禁食禁饮,CHO组在麻醉前2 h口服300 mL碳水化合物。主要指标:用胃超声检查并计算右侧卧位两组胃液量的平均差异与非劣效性界值(Δ)17.05 mL进行比较。次要指标:胃超声下右侧卧位横截面积(CSA)、Perlas分级、单位体重的胃液量(GV/kg)、胃液pH值、患者满意度、胃排空时间。结果胃液量的平均差异为7.18 mL(95%CI:-0.06~14.43),95%CI的上限低于预设的非劣效性限值(Δ=17.05 mL)。Control组和CHO组的平均胃液量差异无统计学意义[40(26,66)mL vs.58(34,65)mL,P=0.43]。两组单位体重的胃液量差异无统计学意义(P=0.66),Perlas分级分布差异无统计学意义(P>0.05)。两组患者满意度差异有统计学意义(P<0.05)。结论根据胃超声评估,肥胖女性手术前2 h摄入300 mL碳水化合物胃液量并不劣于午夜禁食。Objective To investigate whether the gastric juice volume(GV)of obese women who took carbohydrate 2 hours before operation was equal to or less than that of those who are not routine drinking.Methods Obese patients undergoing elective laparoscopic gynecological surgery under general anesthesia with BMI of 28-32 kg/m^(2) and ASA grade ofⅠ-Ⅱ,aged 18-65 years old were selected.The patients were divided into the carbohydrate group(CHO group)and the fasting group(Control group)by random number table method,with 51 cases in each group.The Control group was fasted from 11 pm before surgery,while the CHO group was given 300 mL of carbohydrate orally 2 hours before anesthesia.The main outcome measure was compared with a non-inferiority limit(Δ)of 17 mL and the mean difference in gastric juice volume between the two groups in the right lateral decubitus position(RLDP)examined by gastric ultrasound.The secondary outcome measures included CSA in right lateral position under gastric ultrasound,Perlas classification,GV/kg,gastric juice pH value,patient satisfaction and gastric emptying time.Results The mean difference of gastric juice volume was 7.18 mL(95%CI:-0.06 to 14.43),and the upper limit of 95%CI was lower than the preset non-inferiority limit(Δ=17.05 mL).There was no statistically significant difference in the mean(standard deviation)gastric juice volume between the control group and the CHO group[40(26,66)mL vs.58(34,65)mL;P=0.43].The gastric volume GV/kg was similar in the two groups(P=0.66),and there was no significant difference in the number distribution of Perlas grades between the two groups(P>0.05).There was significant difference in patient satisfaction between the two groups(P<0.05).Conclusion According to the evaluation of gastric ultrasound,compared with fasting at midnight,300ml carbohydrate intake at 2 hours before surgery is not inferior to fasting at midnight in terms of gastric fluid volume in obese women as assessed by gastric ultrasound.

关 键 词：胃超声 肥胖 碳水化合物 腹腔镜 妇科手术 

分 类 号：R614[医药卫生—麻醉学]