吴红利　　李清平　　郭健军　　王磊

[摘要] 目的 探討超声在评估合并糖尿病骨折内固定手术患者胃排空中的应用，指导降低患者胃内容物反流误吸风险。 方法 选取本院2019年2月至2020年6月期间骨折内固定手术合并糖尿病患者64例为观察组，并选择无糖尿病骨折内固定手术患者40例作为对照组，利用超声监测两组患者胃窦截面积、胃收缩频率及胃内容物等变化，评估比较反流误吸风险。 结果 两组餐后即刻胃窦截面积比较无明显差异（t=1.019，P>0.05）;观察组餐后即刻胃收缩频率明显低于对照组（t=5.312，P<0.05）。T1时刻两组胃排空率比较无明显差异（t=1.130，P>0.05），T2、T3、T4等时刻观察组胃排空率均低于对照组（t=6.320、9.714、11.216，P均<0.05）;且观察组误吸风险评分明显高于对照组（Z=2.937，P<0.05）。 结论 糖尿病手术患者围麻醉期误吸风险高于非糖尿病患者，利用超声评估手术患者胃动力可以预判误吸风险。

[关键词] 糖尿病;择期手术;胃动力;误吸风险

[中图分类号] R614;R445.1          [文献标识码] B          [文章编号] 1673-9701（2021）11-0074-03

Ultrasound assessment of the risk of aspiration during perianaesthesia of internal fracture fixation in diabetic patients

WU Hongli LI Qingping GUO Jianjun WANG Lei

Department of Anesthesiology， Chinese Medicine Hospital of Zhoushan City in Zhejiang Province， Zhoushan   316000， China

[Abstract] Objective To explore the application of ultrasound in evaluating gastric emptying in diabetic patients with internal fracture fixation， and to guide the reduction of the risk of gastric contents reflux and aspiration. Methods Sixty-four diabetic patients with internal fracture fixation in our hospital from February 2019 to June 2020 were selected as the observation group， and 40 non-diabetic patients with internal fracture fixation were selected as the control group. The changes of gastric antrum cross-sectional area， gastric contraction frequency， and gastric contents in the two groups were monitored by ultrasound. The risk of reflux aspiration was evaluated and compared. Results There was no significant difference in the cross-sectional area of gastric antrum between the two groups immediately after the meal（t=1.019， P>0.05）. The frequency of gastric contraction immediately after the meal in the observation group was significantly lower than that in the control group（t=5.312， P<0.05）. There was no significant difference in gastric emptying rate between the two groups at T1（t=1.130， P>0.05）. The gastric emptying rate of the observation group at T2， T3， and T4 was lower than that of the control group（t=6.320， 9.714， 11.216， P<0.05）. The aspiration risk score of the observation group was significantly higher than that of the control group（Z=2.937， P<0.05）. Conclusion The risk of aspiration in diabetic patients during perianaesthesia is higher than that in non-diabetic patients. The use of ultrasound to assess gastric motility in surgical patients can predict the risk of aspiration.

[Key words] Diabetes; Elective surgery; Gastric motility; Risk of aspiration

围手术期胃内容物反流误吸是外科手术麻醉常见的并发症，由反流误吸引起的吸入性肺炎可能会诱发更严重的并发症，直接影响患者康复，甚至影响生命[1-2]。禁食禁饮能有效避免反流误吸，但也明显影响了疾病状态下的集体康复。快速康复外科理念（Enhanced recovery after surgery，ERAS）则认为术前适量进食能有效缓解患者术前的饥渴、焦虑，也有利于患者术中的营养供给，同时可以改善胰岛素抵抗，对患者术后的康复有明显帮助[3，4]。

基于糖尿病引起的机体代谢变化，接受外科手术时需要进行慎重的围手术期方案，而慎重的围麻醉期肠道准备更为重要。但糖尿病患者多伴有胃肠道代谢紊乱，部分患者有胃轻瘫症状，发病率高达30%～50%，直接影响胃排空能力[5，6]。因此，明确合并糖尿病手术患者胃排空情况，准确评估围麻醉期误吸风险，有利于糖尿病手术患者围术期安全和康复。本研……