床旁超声评估糖尿病患者术前胃内容物及血糖控制不佳对残余胃容量的影响

Application of point‑of‑care ultrasound for evaluating the effect of preoperative gastric contents and poor glycemic control on residual gastric volume in diabetic patients

目的超声评估糖尿病患者术前胃内容物及血糖控制不佳对残余胃容量(RGV)的影响。方法选择2022年3月至2023年6月于兰州大学第二医院接受择期手术的患者225例,根据入院时血糖检查结果分为3组(每组75例):血糖控制良好组(A组),入院时空腹血糖≤10.0 mmol/L,糖化血红蛋白(HbA1c)≤7%;血糖控制不佳组(B组),入院时空腹血糖>10.0 mmol/L,HbA1c>7%;非糖尿病患者组(C组),入院时空腹血糖<7.0 mmol/L。A组患者入院后继续原有的口服降糖药物治疗方案,B组患者在术前48 h内改用短效/速效胰岛素进行快速调控使血糖≤10.0 mmol/L。在麻醉诱导前,通过床旁超声扫描评估和比较各组患者的胃窦分级(0级、1级和2级)、横截面积(CSA)、RGV及风险胃(RGV>1.5 ml/kg)的发生概率。结果A组和B组胃窦分级为2级的人数、CSA和RGV均高于C组(均P<0.05)。A组和B组胃窦分级、CSA和RGV差异无统计学意义(均P>0.05)。A组和B组风险胃的发生概率、CSA和RGV均高于C组(均P<0.05)。B组风险胃的发生概率、CSA和RGV高于A组,但差异无统计学意义(均P>0.05)。结论在择期手术麻醉前,糖尿病患者RGV显著大于非糖尿病患者,而术前快速血糖调控不能显著降低RGV。

Objective To evaluate the effect of preoperative gastric contents and poor glycemic control on residual gastric volume(RGV)in diabetic patients by ultrasound.Methods A total of 225 patients who underwent elective surgery at the Second Hospital of Lanzhou University from March 2022 to June 2023 were selected.According to the blood glucose levels at admission,the patients were divided into three groups(n=75):a good glycemic control group(group A),with fasting blood glucose≤10.0 mmol/L and glycated hemoglobin(HbA1c)≤7%;a poor glycemic control group(group B),with fasting blood glucose>10.0 mmol/L and HbA1c>7%;and a non‑diabetic patient group(group C),with fasting blood glucose≤7.0 mmol/L at admission.Patients in group A continued their original oral hypoglycemic regimen,while those in group B switched to short/rapid‑acting insulin for rapid glucose regulation to≤10.0 mmol/L within 48 h before surgery.Before anesthesia induction,antral grades(grades 0,1 and 2),cross‑sectional area(CSA),RGV,and the probability of risk stomach(RGV>1.5 ml/kg)were assessed and compared among the groups by point‑of‑care ultrasound.Results The number of patients with antral grade 2,CSA and RGV were significantly higher in group A and group B than those in group C(all P<0.05).There was no statistical difference in antral grades,CSA and RGV between group A and group B(all P>0.05).The probability of risk stomach,CSA and RGV were significantly higher in group A and group B than those in group C(all P<0.05).The probability of risk stomach,CSA and RGV were higher in group B than those in group A,without statistical difference(all P>0.05).Conclusions Before anesthesia for elective surgery,diabetic patients have significantly larger RGV than non‑diabetic patients,while rapid preoperative glycemic control cannot significantly reduce RGV.