麻醉前饮用碳水化合物导致胃排空延迟的危险因素分析

Risk factors for delayed gastric emptying after drinking carbohydrate before anesthesia induction in patients with gastric or colorectal tumors

目的探讨实施加速康复外科(enhanced recovery after surgery,ERAS)临床方案的胃结直肠肿瘤手术患者,麻醉前2～3 h饮用碳水化合物400 ml后胃排空延迟的相关危险因素。方法选择实施ERAS临床方案的胃结直肠肿瘤手术患者96例,男66例,女30例,年龄≥18岁,ASAⅠ—Ⅲ级。在麻醉前2～3 h饮用碳水化合物饮品后,通过超声检查胃窦部,观察患者胃排空状态并和术前空腹6 h后的超声评估进行对照,对可能影响胃排空延迟的相关因素进行单因素及多因素分析。结果麻醉前饮用碳水化合物400 ml后,共14例(15.1%)发生胃排空延迟。胃排空延迟与女性、肿瘤位于胃流出道以及术前禁食禁饮6 h后胃排空延迟等相关。肿瘤位于胃流出道(OR=10.567, 95%CI 1.643～67.959,P=0.013)以及术前禁食禁饮6 h后胃排空延迟(OR=3.667, 95%CI 0.959～38.341,P=0.041)为患者术前饮用碳水化合物后发生胃排空延迟的独立危险因素。结论肿瘤位于胃流出道以及术前禁食禁饮6 h后胃排空延迟是ERAS患者术前饮用碳水化合物后发生胃排空延迟的高危因素,临床实施时应根据其影响因素,规避和降低麻醉诱导期风险。

Objective To study the risk factors of delayed gastric emptying in patients with gastric or colorectal tumor undergoing enhanced recovery after surgery(ERAS)clinical protocols,who drunk 400 ml carbohydrate 2-3 hours before anesthesia induction.Methods Ninety-six patients,66 males and 30 females over 18-year old,ASA physical statusⅠ-Ⅲ,had gastric or colorectal tumor underwent ERAS clinical protocols were collected.After drinking 400 ml carbohydrate 2-3 hours before anesthesia induction,the gastric antrum was scanned by ultrasonography to observe the patient's gastric emptying status and compare with that of 6 h fasting before surgery;besides,univariate and multivariate analyses were performed for the risk factors of delayed gastric emptying.Results There were 14 patients(15.1%)showed delayed gastric emptying after drinking 400 ml carbohydrate.The delayed gastric emptying was associated with female,the tumor located in the stomach outflow and gastric retention after 6 h fasting before surgery.Tumors located in the stomach outflow(OR=10.567,95%CI 1.643-67.959,P=0.013),and delayed gastric emptying after 6 h fasting before surgery(OR=3.667,95%CI 0.959-38.341,P=0.041)were the independent risk factors of delayed gastric emptying for the patients who underwent ERAS clinical scheme after drinking carbohydrate.Conclusion Patients with tumors located in the stomach outflow and delayed gastric emptying after fasting 6h are the independent risk factors of gastric retention for the patients who undergo ERAS clinical protocols after drinking carbohydrate.Clinical implementation should be based on its influencing factors to avoid and reduce the risk during anesthesia induction period.