儿童全身麻醉前饮用碳水化合物与标准禁食的随机对照试验
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Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric anaesthesia
背景与目的
术前禁食是儿科患者围术期不适的主要原因，且可导致术后胰岛素抵抗，从而增强手术炎症反应。患儿术前摄入碳水化合物是否可降低这些情况的发生，目前尚不清楚。
方 法
本试验共纳入2岁至18岁的患儿120例，随机分为对照组和试验组，对照组术前按照6h固体食物、4h母乳、2小时清饮的常规标准禁食，试验组在胃镜检查前夜和检查前2h各口服PreOp牌柠檬口味的碳水化合物溶液5ml/kg。在胃镜检查时通过胃镜吸除胃内容物，记录其容积和pH值。记录术前不适感评分、口渴和饥饿情况以及术后恶心呕吐发生情况 。四岁（含）以下使用观察性疼痛量表（OPS），四岁以上使用VAS评分。
结 果
与对照组相比，试验组患儿胃内容物显著减少（p=0.01），术后恶心发生率更低（p=0.028），术后呕吐发生率无显著差异。试验组仅1例术前VAS评分大于5分，而对照组则有5例。合并肠镜检查组胃内容物体积并不高于单纯胃镜检查组，其他研究结果也与单纯胃镜检查组相同。
结 论
术前给予碳水化合物可减少胃内容物，降低患儿术后恶心发生风险，这为儿童麻醉术前禁食标准的制定提供了依据。
原始文献摘要
Tudor-Drobjewski BA, Marhofer P, Kimberger O, et al. Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric anaesthesia. Br J Anaesth. 2018 Sep;121(3):656-661. doi: 10.1016/j.bja.2018.04.040
Backgrand: Preoperative fasting is a major cause of perioperative discomfort in paediatric anaesthesia and leads to postoperative insulin resistance, thus potentially enhancing the inflammatory response to surgery. Addressing these problems by preoperative carbohydrate intake has not been a well-defined approach in children.
Methed: We randomised 120 children scheduled for gastroscopy under general anaesthesia to either a control group of standard preoperative fasting or a study group receiving a carbohydrate beverage (PreOp™; Nutricia, Erlangen, Germany).
Their stomach contents were aspirated endoscopically, and the volume and pH measured. Perioperative discomfort was evaluated using, among other parameters, an observational pain scale in _4-yr-olds and a VAS in >4-yr-olds. The investigators
doing the endoscopies and outcome evaluations were blinded to the study group allocation.
Results：Compared with fasting, carbohydrate loading was associated with significantly less gastric content (P¼0.01),fewer patients experiencing postoperative nausea (P¼0.028), with no significant difference in postoperative vomiting.High preoperative VAS scores (>5) were recorded for only one child in the carbohydrate group vs five children in the fasting group. Bowel cleansing for simultaneous colonoscopies (n¼61) made no difference to any of the intergroup findings.
Conclusion: Preoperative carbohydrates can reduce nausea and gastric content, the latter being a surrogate parameter for the risk and severity of gastric aspiration into the lungs during anaesthesia. Our study adds knowledge for preoperative fasting guidelines in paediatric anaesthesia
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