胃窦部超声监测下术前2 h口服碳水化合物对OSAHS手术患儿的影响

The Effect of Taking Preoperative Carbohydrates 2 Hours before Surgery on Children with OSAHS by Antral Ultrasonography

目的:探讨在胃窦部超声监测下术前2 h口服不同种类的清饮料对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患儿的影响。方法:选取2020年6-12月昆明市儿童医院收治的104例OSAHS患儿作为研究对象,按随机数字表法分为观察组和对照组,各52例。观察组术前2 h口服碳水化合物5 ml/kg,对照组术前2 h口服清水5 ml/kg。两组患儿进入手术室后均先用超声测量右侧卧位下的胃窦部横截面积(CSA),应用公式计算胃容量(GV)及单位体重胃容量(GV/W)。采外周静脉血测定两组术前及术后血糖、血胰岛素、血胰岛素抵抗指数。观察两组患儿术前焦虑水平和围术期不良反应的发生情况。结果:两组患儿CSA、GV、GV/W等胃超声测量数据比较,差异均无统计学意义(P>0.05)。观察组空腹血糖、胰岛素及胰岛素抵抗指数均明显低于对照组,差异有统计学意义(P<0.05)。观察组患儿入室时焦虑评分和术后恶心呕吐、躁动的发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:胃窦部超声监测OSAHS患儿术前2 h口服碳水化合物5 ml/kg是安全的,可以改善患儿术后胰岛素抵抗,降低患儿术前焦虑水平,同时减少围术期不良反应的发生,从而加速术后康复。

Objective:To investigate the effects of taking oral different kinds of clear liquid 2 hours prior to surgery on children with OSAHS by antral ultrasonography.Method:A total of 104 children with OSAHS in Kunming Children’s Hospital from June to December 2020 were selected and randomly divided into two groups,with 52 cases in each group.The observation group received oral administration of carbohydrates 5 ml/kg 2 hours before operation,while the control group received oral administration of 5 ml/kg clear water 2 hours before operation.After entering the room,the cross-sectional area of gastric antrum(cross-sectional area,CSA)under the right lateral position was measured by ultrasound.Then the gastric volume(gastric volume,GV)and unit weight gastric volume(GV/weight,GV/W)were calculated by the formula.Blood glucose,insulin and insulin resistance index were measured before and immediately after surgery by peripheral venous blood.Preoperative anxiety,and perioperative adverse reactions were compared between two groups.Result:There were no significant differences in measurement data(CSA,GV,GV/W)from gastric ultrasound between the two groups(P>0.05).Compared with the control group,the blood glucose,insulin and insulin resistance index of the observation group were significantly lower(P<0.05).The anxiety scores enter the operating room and the incidence of postoperative nausea and vomiting,emergence agitation of the observation group were lower than the control group,the differences were significant(P<0.05).Conclusion:Taking preoperative carbohydrates 2 hours before surgery on children with OSAHS by antral ultrasonography is safe.It may attenuate immediate postoperative insulin resistance,lower preoperative anxiety,and reduced the incidence of postoperative adverse reactions,so as to speed up postoperative rehabilitation.