碳水化合物负荷用于硬膜外麻醉剖宫产术患者术前准备的效果

Efficacy of carbohydrate loading for preoperative preparation in patients undergoing cesarean sec-tion under epidural anesthesia

目的评价碳水化合物负荷用于硬膜外麻醉剖宫产术患者术前准备的效果。方法选择择期剖宫产术患者4JD例，年龄20-35岁，体重指数19-30kg／m^2，ASA分级I级。采用信封法随机分为2组（n=20）：碳水化合物组（CA组）和安慰剂组（C组）。CA组于术前2h口服300ml碳水化合物饮品（含碳水化合物14．1g／100m1），C组术前2h口服等容量蒸馏水。患者术前晚常规禁食禁水，采用连续硬膜外麻醉，术中采用乳酸钠林格液1500ml维持容量。CA组于空腹时、口服后即刻、口服后2h时采用超声测量胃窦前后径（AP）、左右径（LR）及此切面胃窦面积。胎儿娩出后，采集患者静脉血样，采用竞争酶联免疫吸附法测定血清丙二醛（MDA）浓度。记录入室后口渴、饥饿和焦虑评分。记录术后0-12h、12-24h恶心呕吐的发生情况。结果与C组比较，CA组饥饿评分和血清MDA浓度降低（P〈0．05或0．01），口渴和焦虑评分、术后恶心呕吐发生率差异无统计学意义（P〉0．05）。与空腹时比较，CA组口服后2h时AP、LR和胃窦面积差异无统计学意义（P〉0．05）。结论术前2h碳水化合物负荷可改善硬膜外麻醉剖宫产术患者术前准备效果，不增加反流误吸的风险。

Objective To evaluate the efficacy of carbohydrate loading for preoperative preparation in the patients undergoing cesarean section under epidural anesthesia. Methods Forty American Society of Anesthesiologists physical status I patients, aged 20-35 yr, with body mass index of 19-30 kg/m2, scheduled for elective cesarean section, were divided into 2 groups (n = 20 each） by envelope method ： carbohydrate group （group CA） and placebo group （group C). Carbohydrate drinks 300 ml containing carbohydrate 14. 1 g/100 ml was taken orally at 2 h before surgery in group CA, and the equal volume of distilled waster was taken orally instead in group C. Patients underwent routine preoperative fasting on the night before surgery, continuous epidural anesthesia was used, and lactated Ringer＇s solution 1 500 ml was given to maintain the volume during surgery. Anteroposterior diameter and left-right diameter of gastric an-trum and area of gastric antrum in this section were measured at fasting, immediately after oral intake and at 2 h after oral intake in group CA. Venous blood samples were collected after delivery of the baby for deter-mination of serum malondialdehyde concentrations by competitive enzyme-linked immunosorbent assay. Thirst, hunger and anxiety scores were recorded after entering the operating room. The development of nau-sea and vomiting was also recorded in 0-12 h and 12-24 h periods postoperatively. Results Compared with group C, the hunger scores and concentration of serum malondialdehyde were significantly decreased (P〈0. 05 or 0. 01) , and no significant change was found in thirst and anxiety scores or incidence of nausea and vomiting in group CA （P〉0. 05）. No significant changes were observed in anteroposterior diameter, left-fight diameter and area of gastric antrum at 2 h after the oral intake when compared with that at fasting （P〉0. 05）. Conclusion Carbohydrate loading at 2 h before surgery can improve the efficacy of preopera-tive preparation without increasing the risk of reflux or aspiration in the patients undergoing cesarean section under epidural anesthesia.