术前口服不同容量碳水化合物对腹腔镜妇科手术患者胃液量的影响

Effect of preoperative oral carbohydrate of different volumes on gastric juice volume in patients undergoing laparoscopic gynecological surgery

目的比较术前2 h口服不同容量碳水化合物(CHO)对腹腔镜妇科手术患者胃液量的影响。方法选择全身麻醉下行腹腔镜妇科手术患者120例,年龄18~55岁,BMI 18~28 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法分为四组:常规禁饮组(对照组)、口服CHO 200 ml组(C200组)、口服CHO 300 ml组(C300组)和口服CHO 400 ml组(C400组),每组30例。对照组常规禁饮,C200组、C300组和C400组术前2 h分别口服CHO 200、300、400 ml。入手术室后,超声测量平卧位、右侧卧位胃窦部横截面积并行Perlas等级评分。常规全麻诱导插入I-gel喉罩后置入多孔鼻胃管抽吸胃液,测定胃液量。记录口服CHO前、口服CHO 2 h后的口渴及饥饿VAS评分、状态-特质焦虑量表(STAI-Y)评分。结果与对照组比较,C400组胃液量明显增多(P<0.05)。与C400组比较,对照组和C200组Perlas 2级比例明显降低(P<0.05)。对照组、C200组和C300组Perlas分级比例差异无统计学意义。与口服CHO前比较,口服CHO 2 h后C300组和C400组口渴VAS评分、STAI-Y评分明显降低(P<0.05)。与C200组比较,口服CHO 2 h后C300组和C400组口渴VAS评分、STAI-Y评分明显降低(P<0.05)。结论术前2 h口服碳水化合物300 ml在腹腔镜妇科手术患者中安全可靠,不引起胃液量明显改变,不增加反流误吸风险,且可显著改善术前口渴、焦虑的主观不适。

Objective To compare the effect of oral administration of 12.5%carbohydrate(CHO)with different volume 2 hours before surgery on gastric juice volume.Methods A total of 120 patients,aged 18-55 years,BMI 18-28 kg/m^(2),ASA physical statusⅠorⅡ,were selected for laparoscopic gynecological surgery under general anesthesia.Randomized number table method was used to divide the patients into four groups:drinking prohibition group(group control),oral CHO 200 ml group(group C200),oral CHO 300 ml group(group C300),and oral CHO 400 ml group(group C400),30 patients in each group.Group control was routinely forbidden to drink,and groups C200,C300,and C400 were given CHO 200,300 and 400 ml orally 2 hours before surgery,respectively.After entering the operating room,the cross-sectional area of gastric antrum was measured under ultrasound in supine position and right lateral position,and the Perlas grade was scored.The gastric fluid was aspirated through a porous nasogastric tube after the insertion of an I-gel laryngeal mask under general anesthesia,and the gastric fluid volume were measured.VAS scores of thirst and hunger and STAI-Y scores of anxiety were recorded before taking CHO orally and 2 hours after taking CHO.Results Compared with the group control,the gastric juice volume in group C400 increased significantly(P<0.05).Compared with group C400,the proportion of Perlas grade 2 in group C200 was significantly decreased(P<0.05).There was no significant difference in the proportion of Perlas grading among the group control,group C200,and group C300.Compared with before taking CHO,VAS score of thirst and STAI-Y score of anxiety in group C300 and group C400 were significantly lower 2 hours after taking CHO(P<0.05).At 2 hours after taking CHO,VAS score of thirst and STAI-Y score of anxiety in group C300 and group C400 were significantly lower than those in group C200(P<0.05).Conclusion Oral administration of CHO 300 ml 2 hours before operation is safe and reliable in patients undergoing laparoscopic gynecological surgery,which will not increase the risk of aspiration,and can significantly improve the subjective discomfort of thirst and anxiety before operation.