分娩镇痛产妇不同饮食后超声观察胃排空的临床研究

Clinical study on ultrasound observation of gastric emptying in parturients undergoing labor analgesia with different diets

目的观察分娩镇痛产妇进食不同食物后使用超声评估胃排空的情况。方法选择2020年10月至2021年6月足月、单胎、头位自愿接受硬膜外分娩镇痛初产妇80例,美国麻醉医师协会(ASA)Ⅱ级,进入产程前禁食6~8 h,禁饮2~4 h。随机数字表法将产妇分为2组,每组40例,碳水化合物饮料(CHO)组和对照组。胃窦部超声由一位经过培训的麻醉医师执行,分娩镇痛后即刻(T0)超声测量产妇基础标准矢状切面胃窦横截面积(CSA)。随后CHO组在20 min内饮用碳水化合物饮料400 ml,分别在饮用CHO后30 min(T1)、60 min(T2)、90 min(T3)、120 min(T4)、150 min(T5)、180 min(T6)测量CSA,直到CSA测量值≤T0定义为排空,再根据需求饮用碳水化合物饮料直到分娩结束。对照组20 min内食用营养科统一配制容积为400 ml的面条汤,分别在30 min(T1)、60 min(T2)、90 min(T3)、120 min(T4)、150 min(T5)、180 min(T6)、240 min(T7)、300 min(T8)和360 min(T9)测量CSA,任何时间点测量CSA≤T0,同时看不到胃内有固体颗粒定义为排空,胃容量根据CSA计算得出。记录2组产程时长、分娩方式、缩宫素使用率、恶心呕吐的发生率、新生儿1 min、5 min Apgar评分。结果8名产妇中转剖宫产和2名产妇超声图像成像质量差被剔除。CHO组50%胃排空率为120 min,对照组50%胃排空率为360 min,差异有统计学意义(P<0.05)。T1~T6任一时间点对照组胃容量显著高于CHO组,差异有统计学意义(P<0.05)。2组产妇在产程时长、分娩方式、缩宫素使用率、恶心呕吐发生率、新生儿Apgar评分差异无统计学意义(P>0.05)。结论与食用面条汤相比,碳水化合物饮料不增加分娩镇痛产妇胃容量,具有胃排空快,胃内残留低,不影响产程时长和母婴分娩结局等优势,安全可行。

Objective To observe gastric emptying after different diets on maternal who accepted analgesia in labor.Methods From October 2020 to June 2021 collected eighty primiparous women at term,with singleton pregnancies and in the cephalic presentation,voluntarily opted for epidural labor analgesia,ASAⅡclassification.They fasted for 6~8 hours before entering labor and refrained from drinking for 2~4 hours.Using random number assignment,the parturients were divided into the Carbohydrate Beverage(CHO)group and the control group,40 in each group.Ultrasound of the gastric antrum is performed by a trained anesthesiologist.Immediately after labor analgesia(T0),ultrasound was used to measure the baseline crosssectional area(CSA)of the gastric antrum in the sagittal plane.Subsequently,the CHO group consumed 400 ml of carbohydrate beverage within 20 minutes,and CSA was measured at after drink CHO 30 min(T1),60 min(T2),90 min(T3),120 min(T4),150 min(T5),and 180 min(T6)until CSA≤T0.Gastric emptying was defined as CSA measurement≤T0,and carbohydrate beverage was consumed as needed until delivery was completed.The control group consumed 400 ml of nutritionally standardized noodle soup within 20 min,and CSA was measured at 30 min(T1),60 min(T2),90 min(T3),120 min(T4),150 min(T5),180 min(T6),240 min(T7),300 min(T8),and 360 min(T9).Any time point at which CSA≤T0 and solid particles were not observed in the stomach was considered as gastric emptying.Gastric volume was calculated based on CSA.The duration of labor,mode of delivery,oxytocin use,incidence of nausea and vomiting,and 1 min and 5 min Apgar scores of newborns were recorded.Results Eight cases of cesarean section and two cases of poor ultrasound image quality were excluded.The 50%gastric emptying time was 120 min in the CHO group and 360 min in the control group,with statistically significant differences(P<0.05).At any time point from T1 to T6,gastric volume in the control group were significantly higher than those in the CHO group(P<0.05),with statistically significant difference.There were no statistically significant differences between the two groups in terms of duration of labor,mode of delivery,oxytocin use,incidence of nausea and vomiting,and Apgar scores of newborns(P>0.05).Conclusion Compared with consumption of noodle soup,carbohydrate beverage does not increase gastric volume in parturient receiving labor analgesia,and it has the advantages of rapid gastric emptying,low gastric residue,and no effect on duration of labor and maternalneonatal delivery outcomes.It is safe and feasible.