术前口服碳水化合物对腹腔镜胆囊切除术患者胃排空的影响

Effect of preoperative oral carbohydrate on gastric emptying in patients undergoing laparoscopic cholecystectomy

目的评价术前口服碳水化合物对腹腔镜胆囊切除术患者胃排空的影响。方法择期行腹腔镜胆囊切除术胆石症患者100例,性别不限,年龄18~64岁,BMI 18~30 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=50):传统禁食禁饮组(C组)和术前口服碳水化合物组(P组)。2组术前晚20:00后均禁固体食物,C组术前晚21:30后禁饮,P组术前晚21:30服用12.5%碳水化合物800 ml,并于术晨05:00至05:30服用同类碳水化合物400 ml。于术日07:30(口服碳水化合物后2 h,T1)行胃窦部超声检查,确定胃内容物性质,并进行Perlas分级,计算半坐位和右侧卧位下胃窦横截面积(CSA),计算胃容积(GV)和胃容积体重比值(GV/W比值)。胃内含有固体或胃内容物为液体且GV>1.5 ml/kg定义为饱胃状态。T1时评估为饱胃的患者,于麻醉诱导前(口服碳水化合物后3 h,T2)再次行胃窦超声检查。记录T1、T2时饱胃发生情况,T2时记录患者饥饿感、口渴感以及禁食期间满意度评分,记录返流误吸、术后24 h恶心呕吐发生情况、术后首次肠道排气时间和术后总住院时间。结果与C组比较,T1时P组半坐位CSA、右侧卧位CSA、GV、GV/W比值、饱胃发生率和Perlas分级增加(P<0.05),T2时饱胃发生率差异无统计学意义(P>0.05),术前饥饿感、口渴感评分下降,满意度评分升高,术后24 h恶心呕吐发生率降低,术后首次排气时间缩短(P<0.05),术后总住院时间差异无统计学意义(P>0.05)。结论胆石症患者腹腔镜胆囊切除术前口服碳水化合物可能存在胃排空延迟,可适当前移口服碳水化合物的时间窗(术前3 h)。

Objective To evaluate the effect of preoperative oral carbohydrate on gastric emptying in the patients undergoing laparoscopic cholecystectomy.Methods One hundred patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical statusⅠorⅡ,were divided into 2 groups(n=50 each)using the random number table method:control group(group C)and preoperative oral carbohydrate group(group P).Patients underwent solid food fasting after 20:00 on the night before surgery in both groups and drinking fasting after 21:30 on the night before surgery in group C.Group P received 800 ml of 12.5%oral carbohydrate at 21:30 on the night before surgery and 400 ml of oral similar carbohydrate from 5:00 to 5:30 in the morning before surgery.All the patients underwent ultrasound examination of the gastric sinus at 7:30 on the operation day(2 h after oral carbohydrate,T1)to determine the nature of gastric contents according to the qualitative analysis of images,and Perlas grade was performed,and the cross-sectional area(CSA)of the gastric sinus in a semi-sitting position and right lateral decubitus position was calculated,and gastric volume(GV)and gastric volume to weight ratio(GV/W)were calculated.For solids in the stomach or GV>1.5 ml/kg was defined as a full stomach.Patients assessed as a full stomach at T1 underwent antrum ultrasonography again before induction of anesthesia(at 3 h after oral carbohydrate,T2).The occurrence of satiety at T1 and T2 in each group was recorded.The patient′s hunger score,thirst score,and satisfaction score during fasting were recorded at T2.The reflux aspiration,occurrence of nausea and vomiting at 24 h after operation,postoperative time to first flatus and postoperative total length of hospital stay were recorded.Results Compared with group C,the CSA in a semi-sitting position,CSA,GV and GV/W ratio in a right lateral decubitus position,incidence of satiety,and Perlas grade were significantly increased at T1(P<0.05),no significant change was found in the incidence of satiety at T2(P>0.05),preoperative hunger and thirst scores were significantly decreased,satisfaction scores were increased,the incidence of nausea and vomiting was decreased at 24 h after surgery,and the postoperative time to first flatus was shortened(P<0.05),and no significant change in the postoperative total length of hospital stay was found in group P(P>0.05).Conclusions Oral carbohydrates before laparoscopic cholecystectomy may result in delayed gastric emptying in the patients with cholelithiasis,and the time window for oral carbohydrates can be appropriately shifted forward(3 h before surgery).