急诊骨科患儿术前禁食的适宜时间与进食-创伤间期的关系

Relationship between optimum preoperative fasting time and intervals between eating and trauma in pediatric patients undergoing emergency orthopedic surgery

目的 通过超声测量胃窦部横截面积（CSA）,探讨急诊骨科患儿术前禁食的适宜时间与进食-创伤间期的关系.方法 择期骨科手术患儿50例,年龄2～7岁,ASA分级Ⅰ或Ⅱ级,体重10 ～ 25 kg,采用随机数字表法,将其分为2组（n=25）：禁食6h组（CA组）和禁食8h组（CB组）;急诊骨科手术患儿75例,年龄2～7岁,ASA分级Ⅰ或Ⅱ级,体重10～ 25 kg,根据进食-创伤间期分3组：进食-创伤间期≤1h组（TA组,n=22）、进食-创伤间期＞1h且≤4h（TB组,n=26）,进食-创伤间期＞4h（TC组,n=27）.CA组于距末次进食6 h（T1）时、CB组于距末次进食8 h（T2）时测量CSA,TA、TB、TC组于T1、T2时测量CSA.结果 CA组与CB组CSA比较差异无统计学意义（P＞0.05）.与CA组比较,TA组和TB组CSA增大（P＜0.05）,TC组差异无统计学意义（P＞0.05）;与CB组比较,TA组CSA增大（P＜0.05）,TB组和TC组差异无统计学意义（P＞0.05）;与TA组比较,TC组T1时、TB组和TC组T2时CSA减小（P＜0.05）,TB组T1时差异无统计学意义（P＞0.05）;与TB组比较,L时TC组CSA减小（P＜0.05）,T2时差异无统计学意义（P＞0.05）;与T1时比较,T2时TB组CSA减小（P＜0.05）,TA组和TC组差异无统计学意义（P＞0.05）.结论 对于急诊骨科患儿,进食-创伤间期1～4h之间建议术前禁食时间达到8h;进食-创伤间期＜1h时,即使禁食8h仍不能达到禁食目的,应做好应对返流误吸的措施;进食-创伤间期＞4h时者可适当缩短术前禁食时间至6h.

Objective To evaluate the relationship between the optimum preoperative fasting time and in tervals between eating and trauma in pediatric patients undergoing emergency orthopedic surgery by measuring the gastric antral cross-sectional area （CSA） using ultrasound.Methods Fifty ASA physical status Ⅰ or Ⅱ pediatric patients,aged 2-7 yr,weighing 10-25 kg,undergoing elective orthopedic surgery,were randomly divided into 2 groups （n =25 each） using a random number table：6-h fast group （group CA） and 8-h fast group （group CB）.Seventy-five ASA physical status Ⅰ or Ⅱ pediatric patients,aged 2-7 yr,weighing 10-25 kg,undergoing the emergency orthopedic surgery,were randomly divided into 3 groups according to the interval between eating and trauma：interval ≤ 1 h group （TA group,n =22）,1 h ＜ interval ≤ 4 h group （TB group,n =26） and interval ＞ 4 h group （TC group,n =27）.CSA was measured at 6 h after the last eating （T1） in group CA,8 h after the last eating （T2） in group CB and T1 and T2 in TA,TB and TC groups.Results There was no significant difference in CSA between group CA and group CB （P ＞ 0.05）.Compared with group CA,CSA was significantly enlarged in TA and TB groups （P ＜ 0.05） and no significant change was found in group TC （P ＞ 0.05）.Compared with group CB,CSA was significantly enlarged in TA group （P ＜ 0.05）,and no significant change was found in TB and TC groups （P ＞ 0.05）.Compared with group TA,CSA was significantly decreased at T1 in TC group and T2 in TB and TC groups （P ＜ 0.05）,and no significant change was found at T1 in TB group （P ＞ 0.05）.Compared with group TB,CSA was significantly decreased at T1 （P ＜ 0.05）,and no significant change was found at T2 in TC group （P ＞ 0.05）.Compared with the CSA measured at T1,CSA was significantly decreased at T2 in TB group （P ＜ 0.05）,and no significant change was found at T2 in TA and TC groups （P ＞0.05）.Conclusion For the pediatric patients undergoing emergency orthopedic surgery,when the interval between eating and trauma is within the period of 1-4 h,an 8-h preoperative fast is recommended; when the interval ＜ 1 h,an 8-h preoperative fast is still not able to achieve the aim of fasting and measures should be taken to avoid regurgitation of gastric contents; when the interval ＞ 4 h,the preoperative fasting time can be properly shortened to 6h.