华西医学

华西医学

不同术前禁食禁饮时间对我国择期全身麻醉患者围手术期影响的系统评价

查看全文

目的系统评价不同术前禁食禁饮(non-peros,NPO)时间(试验组:术前禁食 6 h,禁饮 2~3 h;对照组:术前禁食 12 h,禁饮 4~6 h)对我国择期全身麻醉(全麻)患者围手术期有效性与安全性的影响。方法计算机检索 PubMed、Cumulative Index to Nursing and Allied Health、Embase、Cochrane Library、中国生物医学文献数据库、中国知网、维普、万方数据库、SUMsearch 和 Google 搜索引擎,且追溯纳入文献或相关文献的参考文献,查找自建库至 2018 年 4 月 25 日国内关于择期全麻手术患者 NPO 时间的随机对照试验和准随机对照试验。由 2 位评价员独立筛选文献及提取资料,采用 Cochrane 干预措施系统评价手册(5.1.0)中针对随机对照试验的偏倚风险评估工具进行评价后,采用 RevMan 5.3 软件进行 Meta 分析。结果共纳入 16 个研究,包括 2 722 例择期全麻手术患者(试验组 1 372 例,对照组 1 350 例)。Meta 分析结果显示:试验组术前残余胃液量[均数差(mean difference,MD)=–1.45 mL,95% 置信区间(confidence interval,CI)(–2.88,–0.01) mL,P=0.05]、术前低血糖反应发生率[比值比(odds ratio,OR)=0.12,95%CI(0.05,0.28),P<0.000 01]、术前口渴发生率[OR=0.15,95%CI(0.11,0.21),P<0.000 01]、术前饥饿发生率[OR=0.13,95%CI(0.10,0.18),P<0.000 01]、术前心慌疲乏无力发生率[OR=0.11,95%CI(0.07,0.17),P<0.000 01]和术前焦虑发生率[OR=0.21,95%CI(0.12,0.37),P<0.000 01]均低于对照组。试验组与对照组的术中残余胃液量差异无统计学意义(P>0.05),且两组均无患者发生术中呕吐、误吸。术后肛门恢复排气排便时间明显短于对照组[MD=–8.71 h,95%CI(–11.43,–6.00)h,P<0.000 01],而两组患者术后肺炎发生率、术后恶心发生率、术后呕吐发生率及术后口渴、饥饿发生率差异均无统计学意义(P>0.05)。结论与目前传统术前禁食 12 h、禁饮 4~6 h 相比,术前禁食 6 h、禁饮 2~3 h 明显降低术前低血糖反应发生率、减轻术前口渴、饥饿、心慌疲乏无力和焦虑发生率;但并未增加患者术中和术后不良反应发生率,同时明显缩短了术后肛门恢复排气排便时间。鉴于纳入研究数量和质量有限,上述结论尚需展开更多大样本、高质量的随机对照试验予以验证。

ObjectiveTo systematically review the efficacy and safety of different non-peros (NPO) times [( trial group: preoperative solid fast, 6 hours; fluid fast 2–3 hours) vs. (control group: preoperative solid fast, 12 hours; fluid fast 4–6 hours)] in elective general anesthesia patients in China.MethodsRandomized controlled trials (RCTs) and quasi-RCT of NPO time in elective general anesthesia patients were searched and retrieved through online databases (PubMed, Cumulative Index to Nursing and Allied Health, Embase, Cochrane Library, China Biology Medicine database, China National Knowledge Internet, VIP, WanFang, SUMsearch, and Google search engine) and related literatures were reviewed up to April 25th, 2018. Two investigators independently screened literatures, extracted data, and evaluated the risk of bias assessment tools for RCT using the Version 5.1.0 of Cochrane Handbook for Systematic Reviews of Interventions. Then, Meta-analysis was performed using RevMan 5.3 software.ResultsA total of 16 RCTs involving 2 722 elective general anesthesia patients (1 372 in the trial group and 1 350 in the control group) were included. The Meta-analysis showed that: the preoperative residual gastric volume [mean difference (MD)=–1.45 mL, 95% confidence interval (CI) (–2.88, –0.01) mL, P=0.05], the incidence of preoperative hypoglycemia [odds ratio (OR)=0.12, 95%CI (0.05, 0.28), P<0.000 01, the incidence of preoperative thirst [OR=0.15, 95%CI (0.11, 0.21), P<0.000 01], the incidence of preoperative hunger [OR=0.13, 95%CI (0.10, 0.18), P<0.000 01], the incidence of preoperative flustered tiredness [OR=0.11, 95%CI (0.07, 0.17), P<0.000 01], and the incidence of preoperative anxiety [OR=0.21, 95%CI (0.12, 0.37), P<0.000 1] in the trial group were significantly lower than those in the control group. There was no statistically significant difference in the intra-operative residual gastric volume between the two groups (P>0.05), and no intra-operative vomiting or aspiration took place in either group. The recovery time of exhaust and defecate of anus [MD=–8.71 hours, 95%CI (–11.43, –6.00) hours, P<0.000 01] in the trial group was significantly shorter than control group, and there was no statistically significant differences in the incidence of postoperative pneumonia, postoperative nausea, postoperative vomiting, or the postoperative thirsty and hungry between the two groups (P>0.05).ConclusionsCurrent evidence shows that, compared with the control group, the trial group could decrease the incidences of preoperative hypoglycemia, thirst, hunger, flustered tiredness and anxiety, and shorten the recovery time of exhaust and defecate of anus for postoperative patients, without increasing incidences of intraoperative or postoperative adverse reactions. Due to the limited quantity and quality of the included studies, the above conclusions still need to be verified by carrying out more large-scale samples and high-quality RCTs studies.

关键词: 术前禁食禁饮; 择期全身麻醉患者; 随机对照试验; Meta 分析; 系统评价

Key words: Non-peros; Elective general anesthesia patients; Randomized controlled trial; Meta-analysis; Systematic review

引用本文: 左红霞, 张超, 黄健健, 王梦荷, 郑晓明, 秦敏, 牛玉明. 不同术前禁食禁饮时间对我国择期全身麻醉患者围手术期影响的系统评价. 华西医学, 2018, 33(8): 1005-1014. doi: 10.7507/1002-0179.201605045 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol, 1946, 52: 191-205.
2. 仲剑平. 医疗护理技术操作常规. 4 版. 北京: 人民军医出版社, 1998: 963.
3. 蔡明. 择期手术患者术前禁食、禁饮的现状与进展. 解放军护理杂志, 2006, 23(12): 42-43.
4. 王前新. 外科护理学. 北京: 高等教育出版社, 2010: 43.
5. 曹伟新, 李乐之. 外科护理学. 3 版. 北京: 人民卫生出版社, 2002: 62.
6. 曹伟新, 李乐之. 外科护理学. 4 版. 北京: 人民卫生出版社, 2006: 72.
7. Phillips S, Daborn AK, Hatch DJ. Preoperative fasting for paediatric anaesthesia. Br J Anaesth, 1994, 73(4): 529-536.
8. Moro ET. Prevention of pulmonary gastric contents aspiration. Rev Bras Anestesiol, 2004, 54(2): 261-275.
9. Crenshaw JT, Winslow EH. Preoperative fasting: old habits die hard. Am J Nurs, 2002, 102(5): 36-44.
10. Allison J, George M. Using preoperative assessment and patient instruction to improve patient safety. AORN J, 2014, 99(3): 364-375.
11. 孙德峰, 安刚. 术前禁食和应用药物减少肺部误吸危险实用指南. 临床麻醉学杂志, 2005, 21(1): 68-69.
12. American Society of Anesthesiologist Task Force on Preoperative Fasting. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology, 1999, 90(3): 896-905.
13. Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr, 2013, 37(2): 285-305.
14. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. http://www. cochrane-handbook.org.
15. 乌云, 郭培俊, 李秀清, 等. 腹腔镜胆囊切除术术前禁食方案的选择. 内蒙古医学杂志, 2011, 43(12): 1466-1468.
16. 明芳, 方晓平, 余燕子, 等. 腹部择期手术术前新禁食方案的研究. 中华护理杂志, 2006, 41(10): 869-873.
17. 胡晓华, 付静. 术前新禁食方案对腹部择期手术患者的影响. 当代护士: 学术版, 2013(12): 1-2.
18. 钟宝英, 李斌, 郑怡, 等. 禁食禁水时间对妇科腹腔镜手术患者不良反应的影响. 中华现代护理杂志, 2014, 20(15): 1812-1815.
19. 付宁, 丁月霞, 张松. 术前禁食、禁饮时限对腹腔镜胆囊切除的影响. 中国基层医药, 2010, 17(19): 2725-2726.
20. 杜吉萍. 术前禁食禁饮时间过长对全身麻醉病人的影响. 护理研究: 下旬版, 2005, 19(30): 2750-2751.
21. 汪佑霖, 许瑞华. 快速康复外科缩短禁食时间在腹腔镜胆囊切除术中的应用. 护士进修杂志, 2012, 27(1): 34-35.
22. 王梅, 陈永惠. 缩短腹部手术术前禁食禁饮时间可行性研究. 安徽卫生职业技术学院学报, 2009, 8(4): 62-63.
23. 章西萍. 缩短经腹腔镜胆囊切除患者术前禁食及禁饮时间的探讨. 中西医结合护理, 2015, 1(3): 90-92.
24. 于秀荣. 术前不同禁食时间对妇科良性肿瘤患者的影响. 齐鲁护理杂志, 2007, 13(2): 14.
25. 刘静静, 秦苗苗. 择期手术患者术前禁食禁饮时间的研究. 科技视界, 2016(9): 296, 309.
26. 周丽平. 围术期禁饮禁食与输液对外科患者康复的影响. 医学美学美容: 中旬刊, 2014(2): 212.
27. 周红艳, 王艳霞. 非胃肠道择期手术患者术前禁食禁饮的研究. 中国医药指南, 2008, 6(19): 111-112.
28. 徐海英, 沈伟. 择期手术患者缩短术前禁食禁饮时间的研究. 护士进修杂志, 2010, 25(2): 109-111.
29. 潘月芳, 许文. 手术前禁食禁饮时间的探讨. 上海护理, 2004, 4(2): 39-40.
30. 薛焱. 外科患者围术期护理中禁食与输液对康复的影响. 浙江临床医学, 2013(7): 1098-1099.
31. Dalal KS, Rajwade D, Suchak R. " Nil per oral after midnight”: is it necessary for clear fluids?. Indian J Anaesth, 2010, 54(5): 445-447.
32. Brady M, Kinn S, Stuart P, et al. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev, 2003(4): CD004423.