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Gastric emptying for liquids of different compositions in children
背景与目的
术前禁食如同天平，病人安全与不适处在天平两端。我们对一种新型透明、高蛋白饮料与传统的透明及非透明营养液的胃排空曲线进行了比较。
方 法
我们对48名健康志愿者进行了前瞻性横断面研究（年龄8~14岁，禁食整夜，无胃肠动力异常危险因素）。受试者按相同机率随机分为饮用296 毫升苹果汁、Ensure牌营养液或2%牛奶。右侧卧位下经超声查见基础状态下、摄取后胃窦横截面积，然后每30 分钟测量一次，直到6h后或恢复到基础水平。由两个麻醉师独立测定、比较饮用不同饮料后各时点胃窦的横截面积。
结 果
通过方差分析发现苹果汁、2%牛奶、Ensure对胃排空时间存在差异（(P<0.0001），男性比女性快（(P<0.01）。通过生存模型或比较90min（P=1.0）,120min（P=0.32）,150min（P=0.11）,180min（P=0.76）或210min（P=1.0）时胃空虚与非空虚状态下的比例，发现间隔时间对胃排空的影响在终末相是相似的（(P=0.17）。
结 论
尽管存在早期差异，然而终末相苹果汁、Ensure牌营养液或2%牛奶胃清除是相似的，而此相是与术前禁食建议最相关的时期。可以基本明确的是，本研究中3种饮料3-3.5 h均被清除。综上，本研究不支持目前指南中关于使用不同液体存在区别的建议。
原始文献摘要
Du T, Hill L, Ding L, Towbin AJ；2017 Nov 1;119(5):948-955. doi: 10.1093/bja/aex340.
BACKGROUND:Pre-operative fasting balances safety against patient discomfort. We compared the gastric emptying profiles of a novel clear, high protein drink against a "traditional" clear and a non-clear fluid.
METHODS:We conducted a prospective cross-sectional study with 48 healthy volunteers, eight to 14 yr of age, fasted overnight and without risk factors for abnormal gastrointestinal motility. Subjects were randomized in equal ratio to ingest 296 ml of apple juice, 2% milk or Ensure Clear. The gastric antrum was seen by ultrasound in the right lateral decubitus position at baseline, after ingestion, then every 30 min thereafter until return to baseline or six h. Gastric antral cross-sectional area was measured independently by two anaesthetists, and compared between drinks.
RESULTS:Gastric emptying differed between apple juice, 2% milk and Ensure Clear by analysis of co-variance (P<0.0001), and was faster in males than females (P<0.01). The terminal phase however was similar using interval-censored time to gastric emptying in a survival model (P=0.17) or by comparing proportions with empty stomach vs not empty at 90 min (P=1.0), 120 min (P=0.32), 150 min (P=0.11), 180 min (P=0.76) or 210 min (P=1.0).
CONCLUSIONS:Despite early differences, clearance from the stomach of apple juice, 2% milk or Ensure Clear is similar at the terminal phase, which is the period of greatest relevance to preoperative fasting recommendations. The stomach is essentially clear by 3-3.5 h for all three drinks studied. The differentiation between liquids in current guidelines is not supported by this study.
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