【罂粟摘要】评估自主神经功能障碍糖尿病患者术前禁食后胃排空情况的比较观察性研究:基于超声的胃充盈率评估

文摘   2024-12-14 07:04   贵州  

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评估自主神经功能障碍糖尿病患者术前禁食后胃排空情况的比较观察性研究:基于超声的胃充盈率评估

贵州医科大学    麻醉与心脏电生理课题组

翻译:周菁          编辑:王波          审校:曹莹



背景

传统上,糖尿病患者被认为是误吸的高风险人群,因为他们存在胃排空延迟;然而,关于空腹糖尿病患者残余胃容积(GV)的证据并不一致。本研究旨在通过胃超声检查,比较糖尿病伴或不伴自主神经病变的患者与择期手术对照患者的空腹胃容积。

方法


本双中心前瞻性单盲病例对照研究在西班牙的两所大学医院进行。纳入年龄超过18岁、美国麻醉医师协会(ASA)生理状态为IIII级且禁食状态相似的患者。主要结局是比较三组患者中使用超声评估的Perlas胃内容物分级量表的风险胃发生率。次要结局包括在右侧卧位(RLD)位置测量横截面积(CSA)和胃容积(GV),以及固体胃残留物的发生率

结果


共招募了289名患者进行研究,其中包括145名糖尿病患者(其中83名患有自主神经病变)和144名对照组患者。对照组中Perlas分级为2级的患者比例为13.2%,无自主神经病变的糖尿病患者中为16.1%,而有自主神经病变的糖尿病患者中为22.9%(P = 0.31)。与对照组(5.4 [4.0–7.2])相比,有自主神经病变的糖尿病患者胃窦横截面积(CSA)显著更高(6.5 [4.8–8.4];P = 0.04)。然而,各组在残余胃容积方面未见显著差异。在有自主神经病变的糖尿病患者中,12%的患者出现固体胃残留物,这一比例是无自主神经病变的糖尿病患者(4.8%)的两倍,也是对照组(3.5%)的三倍(P = 0.03)。在调整混杂因素后,自主神经病变的存在与固体胃残留物发生几率增加相关(优势比[OR],3.37;95%置信区间[CI],1.28–8.87;P = 0.01)


结论


本研究探讨了糖尿病患者中自主神经功能障碍与胃排空延迟之间的关系,强调了术前胃超声评估在管理该人群围手术期风险中的重要性




原始文献来源:Sastre, J. A., López, T., Julián, R., Bustos, D., Sanchís-Dux, R., Molero-Díez, Y. B., Sánchez-Tabernero, Á., Ruiz-Simón, F. A., Sánchez-Hernández, M. V., & Gómez-Ríos, M. Á. (2024). Assessing Full Stomach Prevalence with Ultrasound Following Preoperative Fasting in Diabetic Patients with Dysautonomia: A Comparative Observational Study. Anesthesia & Analgesia. https://doi.org/10.1213/ane.0000000000007110


Assessing Full Stomach Prevalence with Ultrasound Following Preoperative Fasting in Diabetic Patients with Dysautonomia: A Comparative Observational Study

Abstract

Background: Traditionally, diabetics have been considered patients with a high risk of aspiration due to having delayed gastric emptying; However, the evidence concerning residual gastric volume (GV) in fasting diabetic patients is inconsistent. This study aimed to compare the fasting GV of diabetic patients with or without dysautonomia with control patients scheduled for elective surgery using gastric ultrasound.

Method:This bicentric prospective single-blinded case-control study was conducted at 2 university hospitals in Spain. Patients aged over 18 years, classified as American Society of Anesthesiologists (ASA) physical statuses I to III and having similar fasting statuses, were included in the study. The primary outcome was to compare the prevalence of risk stomach using the Perlas gastric content grading scale evaluated by ultrasound in the 3 groups. Secondary outcomes included the measurement of cross-sectional area (CSA) and GV in the right lateral decubitus (RLD) position, as well as the prevalence of solid gastric residue.

Results:: A total of 289 patients were recruited for the study, comprising 145 diabetic patients (83 of whom had dysautonomia) and 144 patients in the control group. The percentage of patients classified as Perlas grade 2 was 13.2% in the control group, 16.1% in diabetic patients without dysautonomia, and 22.9% in diabetic patients with dysautonomia (P = .31). Antral CSA was significantly higher in diabetic patients with dysautonomia (6.5 [4.8–8.4]) compared to the control group (5.4 [4.0–7.2]; P = .04). However, no significant differences were observed between groups in residual GV. Among diabetic patients with dysautonomia, 12% exhibited solid gastric residue, which was twice the percentage observed in diabetic patients without dysautonomia (4.8%) and 3 times higher than that in the control group (3.5%; P = .03). The presence of dysautonomia was associated with an increased odds ratio of solid gastric residue (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.28–8.87; P = .01) after adjusting for confounding factors.

Conclusion:This study offers insights into the relationship between dysautonomia in patients with diabetes mellitus and the presence of full stomach, underscoring the significance of preoperative gastric ultrasound evaluation in managing perioperative risks in this population.

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