健康学龄前儿童早餐后胃排空的超声评价
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Ultrasound assessment of gastric emptying after breakfast in healthy preschool children
背景与目的
目前的指南推荐禁食6小时以减少儿童在麻醉期间误吸的风险。近年来，超声检查已被用来评估麻醉前禁食儿童的胃容量。因此，在本研究中，我们首先评估了在实验条件下超声测量胃容积的准确性，其次通过超声研究了健康学龄前儿童在正常早餐后的胃排空时间。
方 法
在初步实验中，我们把一个梨形的弹性球囊逐步用50ml的水从0ml填充到500ml。每个步骤后，用超声测量球囊窦区面积。此后，通过对健康学龄前儿童正常的早餐后右侧卧位胃窦区面积的超声测量来检查连续两个时间点的胃排空情况。计算出气球球囊窦区面积和气球体积或胃窦区面积和禁食时间的相关系数（皮尔森，95% CI），并通过线性回归推断胃排空时间。数据以平均值（范围）表示。
结 果
在气球实验中，气球体积与球囊窦区面积显著相关（63项测量，r＝96，p＜.0001, 95%，CI 0.93～0.97）。在学龄前儿童的测量中，总共有30名学龄前儿童（年龄47（36-66）个月）进行测量。胃窦区面积与禁食时间显著相关（r＝69，p＜.0001, 95%，CI 0.8～0.51）。最先早餐后的胃窦区面积明显高于其后午餐前的胃窦区面积（10.4 3.7（1.7-17.8）vs 5.5 2.6（1.4-11.8）cm2；平均差5.04，95% CI 6.3～3.8，P<.0001）。计算胃排空平均时间为236分钟。
结 论
气球实验结果显示球囊窦区面积与气球体积呈高度相关性。 在对学龄前儿童的测量中，胃窦区面积与禁食时间相关，平均胃排空时间低于早餐后4小时。这些结果支持常规儿科麻醉在轻食或早餐后更宽松的围手术期禁食方案。
原始文献摘要
Sümpelmann AE1, Sümpelmann R2, Lorenz M3, Eberwien I4, Dennhardt N2, Boethig D5, Russo SG1 Ultrasound assessment of gastric emptying after breakfast in healthy preschool children Paediatr Anaesth. Aug,2017;27(8):816-820.
Background:
In current guidelines, 6 hours of fasting is recommended for solids to limit the risk of pulmonary aspiration during anesthesia in children. Ultrasonography has recently been introduced to evaluate gastric volumes in children in the context of pre-anesthetic fasting. Therefore, in this study, we firstly evaluated the precision of ultrasound assessment of gastric volume in an experimental setting and secondly studied gastric emptying times after a normal breakfast in healthy preschool children using ultrasound.
Methods:
In a preliminary experiment, a pear-shaped elastic balloon was filled and emptied in 50 mL steps from 0 to 500 mL with water. After each step, the balloon antral area was measured using ultrasonography. Thereafter, gastric emptying was examined in healthy preschool children after normal breakfast by sonographic mea-surements of the gastric antral area in right lateral decubitus position at two consec-utive timepoints. Correlation coefficients (Pearson, 95% CI) between the balloon antral area and the balloon volume or gastric antral area and fasting time were cal-culated and gastric emptying time was extrapolated by linear regression. Data are presented as mean (range).
Results:
In the balloon experiment, the balloon volume correlated significantly with the balloon antral area (63 measurements, r=.96, P<.0001, 95% CI 0.93 to 0.97). In the preschool child measurements, a total of 30 children (age 47 (36-66) months) were included. The gastric antral area correlated significantly with fasting time (r= .69,P<.0001, 95% CI 0.8 to 0.51). The first gastric antral area after breakfast was sig-nificantly higher when compared to the second gastric antral area before lunch (10.4 3.7 (1.7-17.8) vs 5.5 2.6 (1.4-11.8) cm2; mean difference 5.04, 95% CI 6.3 to3.8, P<.0001). The calculated mean gastric emptying time was 236 minutes.
Conclusion:
The results of the balloon experiment showed a high correlation between balloon antral area and balloon volume. In the preschool child measurements, gastric antral area correlated with fasting time, and the mean gastric emptying time was lower than 4 hours after breakfast. These results support a more liberal perioperative fasting regimen after a light meal or breakfast in routine pediatric anesthesia.
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