PDF(Pubmed)
Abstract：
UNASSIGNED: The presence of gastric content increases the risk of aspiration during general anesthesia. Diabetic patients have delayed gastric emptying; however, despite adequate fasting because of diabetic gastroparesis these patients have a high risk of aspiration. This study aimed to compare ultrasound-guided measurement of residual gastric volume between diabetic and non-diabetic patients scheduled for elective surgery under general anesthesia.
UNASSIGNED: This prospective observational study included 80 patients divided into two groups of 40 diabetic patients with a minimum of 8 years history of diabetes and 40 nondiabetic patients aged >18 years, American Society of Anesthesiologists\' physical status I-II kept with similar fasting intervals. Before induction of general anesthesia, gastric ultrasound was performed using standard gastric scanning protocol to measure craniocaudal (CC) and anteroposterior (AP) diameters followed by calculation of antral cross-sectional area (CSA) and gastric volume in semi-sitting (SS) and right lateral decubitus (RLD) position using curved array probe. The gastric antrum volume (GV) was classified as Grade 0, 1, or 2, and risk stratification for aspiration was done. The nasogastric tube was inserted after induction of anesthesia to aspirate and compare the gastric content.
UNASSIGNED: In the semi-sitting position, the mean CC and AP diameters were 16.38 ± 3.31 mm and 10.1 ± 2.53 mm in the non-diabetic group and 25.19 ± 4.08 mm and 15.8 ± 3.51 mm in the diabetic group, respectively. In RLD, CC was 1.91 ± 0.38 cm and AP was 1.19 ± 0.34 cm in the non-diabetic group as compared to the CC of 2.78 ± 0.4 cm and AP of 1.81 ± 0.39 cm in the diabetic group. The calculated CSA of 318.23 ± 97.14 mm2 and 4 ± 1.1 cm2 in diabetic were significantly higher than 133.12 ± 58.56 mm2 and 1.83 ± 0.83 cm2 of non-diabetic, in SS (p < 0.0001) and RLD (p < 0.0001) positions, respectively. The GV of 15.48 ± 11.18 ml in the diabetic group was significantly higher than (-) 9.77 ± 18.56 ml in the non-diabetic group (p < 0.0001). Despite the differences in CSA and GV between diabetic and non-diabetic groups, both groups showed a low gastric residual volume (<1.5 ml/kg). The gastric tube aspirate in the non-diabetic and diabetic groups was 0.3 ± 0.78 ml and 1.24 ± 1.46 ml, respectively, and was statistically significant (p = 0.0006).
UNASSIGNED: Patients with long-standing diabetes showed higher gastric residual and antral CSA when compared with non-diabetic patients. The clinical significance of these findings needs further evidence for the formulation of specific guidelines for diabetic patients.
UNASSIGNED: This prospective observational study included 80 patients divided into two groups of 40 diabetic patients with a minimum of 8 years history of diabetes and 40 nondiabetic patients aged >18 years, American Society of Anesthesiologists\' physical status I-II kept with similar fasting intervals. Before induction of general anesthesia, gastric ultrasound was performed using standard gastric scanning protocol to measure craniocaudal (CC) and anteroposterior (AP) diameters followed by calculation of antral cross-sectional area (CSA) and gastric volume in semi-sitting (SS) and right lateral decubitus (RLD) position using curved array probe. The gastric antrum volume (GV) was classified as Grade 0, 1, or 2, and risk stratification for aspiration was done. The nasogastric tube was inserted after induction of anesthesia to aspirate and compare the gastric content.
UNASSIGNED: In the semi-sitting position, the mean CC and AP diameters were 16.38 ± 3.31 mm and 10.1 ± 2.53 mm in the non-diabetic group and 25.19 ± 4.08 mm and 15.8 ± 3.51 mm in the diabetic group, respectively. In RLD, CC was 1.91 ± 0.38 cm and AP was 1.19 ± 0.34 cm in the non-diabetic group as compared to the CC of 2.78 ± 0.4 cm and AP of 1.81 ± 0.39 cm in the diabetic group. The calculated CSA of 318.23 ± 97.14 mm2 and 4 ± 1.1 cm2 in diabetic were significantly higher than 133.12 ± 58.56 mm2 and 1.83 ± 0.83 cm2 of non-diabetic, in SS (p < 0.0001) and RLD (p < 0.0001) positions, respectively. The GV of 15.48 ± 11.18 ml in the diabetic group was significantly higher than (-) 9.77 ± 18.56 ml in the non-diabetic group (p < 0.0001). Despite the differences in CSA and GV between diabetic and non-diabetic groups, both groups showed a low gastric residual volume (<1.5 ml/kg). The gastric tube aspirate in the non-diabetic and diabetic groups was 0.3 ± 0.78 ml and 1.24 ± 1.46 ml, respectively, and was statistically significant (p = 0.0006).
UNASSIGNED: Patients with long-standing diabetes showed higher gastric residual and antral CSA when compared with non-diabetic patients. The clinical significance of these findings needs further evidence for the formulation of specific guidelines for diabetic patients.
摘要：
■胃内容物的存在会增加全身麻醉期间误吸的风险。糖尿病患者胃排空延迟；然而，尽管由于糖尿病性胃轻瘫而禁食足够，但这些患者误吸的风险很高。这项研究旨在比较在全身麻醉下择期手术的糖尿病患者和非糖尿病患者在超声引导下对残余胃体积的测量。
■这项前瞻性观察性研究包括80名患者，分为两组：40名至少有8年糖尿病病史的糖尿病患者和40名年龄>18岁的非糖尿病患者。美国麻醉医师协会的身体状态I-II保持相似的禁食间隔。全身麻醉诱导前，使用标准胃扫描方案进行胃超声检查,测量头尾(CC)和前后(AP)直径,然后使用弯曲阵列探头计算半坐位(SS)和右侧卧位(RLD)的窦横截面积(CSA)和胃体积.胃窦体积（GV）分为0级，1级或2级，并进行了误吸风险分层。麻醉诱导后插入鼻胃管以抽吸并比较胃内容物。
■在半坐姿，非糖尿病组的平均CC和AP直径分别为16.38±3.31mm和10.1±2.53mm，糖尿病组为25.19±4.08mm和15.8±3.51mm。分别。在RLD,非糖尿病组CC为1.91±0.38cm，AP为1.19±0.34cm，糖尿病组CC为2.78±0.4cm，AP为1.81±0.39cm。糖尿病患者计算的CSA为318.23±97.14mm2和4±1.1cm2，明显高于非糖尿病患者的133.12±58.56mm2和1.83±0.83cm2，在SS（p<0.0001）和RLD（p<0.0001）位置，分别。糖尿病组GV为15.48±11.18ml,明显高于非糖尿病组的(-)9.77±18.56ml(p<0.0001)。尽管糖尿病组和非糖尿病组之间的CSA和GV存在差异，两组患者的胃残留量均较低(<1.5ml/kg).非糖尿病组和糖尿病组的胃管抽吸液为0.3±0.78ml和1.24±1.46ml,分别,并且具有统计学意义（p=0.0006）。
■长期糖尿病患者与非糖尿病患者相比，胃残留和窦CSA更高。这些发现的临床意义需要进一步的证据来制定糖尿病患者的具体指南。
■这项前瞻性观察性研究包括80名患者，分为两组：40名至少有8年糖尿病病史的糖尿病患者和40名年龄>18岁的非糖尿病患者。美国麻醉医师协会的身体状态I-II保持相似的禁食间隔。全身麻醉诱导前，使用标准胃扫描方案进行胃超声检查,测量头尾(CC)和前后(AP)直径,然后使用弯曲阵列探头计算半坐位(SS)和右侧卧位(RLD)的窦横截面积(CSA)和胃体积.胃窦体积（GV）分为0级，1级或2级，并进行了误吸风险分层。麻醉诱导后插入鼻胃管以抽吸并比较胃内容物。
■在半坐姿，非糖尿病组的平均CC和AP直径分别为16.38±3.31mm和10.1±2.53mm，糖尿病组为25.19±4.08mm和15.8±3.51mm。分别。在RLD,非糖尿病组CC为1.91±0.38cm，AP为1.19±0.34cm，糖尿病组CC为2.78±0.4cm，AP为1.81±0.39cm。糖尿病患者计算的CSA为318.23±97.14mm2和4±1.1cm2，明显高于非糖尿病患者的133.12±58.56mm2和1.83±0.83cm2，在SS（p<0.0001）和RLD（p<0.0001）位置，分别。糖尿病组GV为15.48±11.18ml,明显高于非糖尿病组的(-)9.77±18.56ml(p<0.0001)。尽管糖尿病组和非糖尿病组之间的CSA和GV存在差异，两组患者的胃残留量均较低(<1.5ml/kg).非糖尿病组和糖尿病组的胃管抽吸液为0.3±0.78ml和1.24±1.46ml,分别,并且具有统计学意义（p=0.0006）。
■长期糖尿病患者与非糖尿病患者相比，胃残留和窦CSA更高。这些发现的临床意义需要进一步的证据来制定糖尿病患者的具体指南。
