胃镜测定残留胃液量探究.docVIP

胃镜测定残留胃液量探究 　【摘要】 目的：胃镜检测常规禁食组和禁食3 h组的胃液量，并测定pH值，比较有无组间差异。方法：对15例常规禁食患者以及15例禁食3 h患者进行普通胃镜检查，胃镜下抽取全部胃液，计总量并测定pH值。结果：常规禁食组平均禁食时间13.83 h，平均胃液量(35.47±13.04)ml，平均pH值(2.22±1.13)；禁食3 h组平均禁食时间3.57 h，平均胃液量(42.75±21.52)ml，平均pH值(3.30±1.03)。两组间胃液量比较，差异无统计学意义，两组间pH值比较，差异无统计学意义。结论：一般择期手术患者不必术前长时间禁食，手术前3 h口服液体肠内营养剂（瑞素500 ml）并不明显增加胃液量。 【关键词】 胃镜；胃液；瑞素；胃排空 　　Study of Gastric Fluid Measurement by Gastric Endoscopy Abstract： Objective To measure the volume and PH value of gastric fluid by gastric endoscopy and orion 720A pH apparatus in routine fasting group and 3 h fasting group. Methods Endoscopy were performed in 15 routine fasting patients and fifteen 3 h fasting patients. Gastric fluid were collected. The volume and PH value of gastric fluid were measured. Results In routine fasting group,the average fasting time was 13.83 h, the average volume of gastric fluid was (35.47±13.04)ml, the average pH value of gastric fluid was (2.22±1.13), In 3 h fasting group,the average fasting time was 3.57 h, the average volume of gastric fluid was (42.75±21.52)ml, the average pH value of gastric fluid was (3.30±1.03). There was no significant difference between two groups. Conclusion Overnight fast was not necessary for patients who would undergo selective operation. The volume of gastric fluid was not increased significantly when 500 ml of fresubin were given 3 h before selective operation. Key words： Gastric endoscopy； Gastric fluid；Fresubin；Gastric empty 择期手术患者夜间禁食作为手术前常规，已经有100多年历史了。禁食的主要目的是减少麻醉时酸性胃内容物发生误吸的风险。但是这一观点现在却越来越遭到人们的质疑。实时超声法和同位素闪烁法胃动力学测定已经表明，正常人排空一份500 ml的Lundh试餐需时(120±30)min［1］。常规的12 h～18 h禁食实无必要。另外，术前长时间禁食使肝糖原耗尽，并开始出现功能减退，同时肠黏膜功能亦下降并出现萎缩。动物应激实验证明，肝糖原储备量的减少与动物死亡密切相关［2］。即使是短时间禁食，对准备手术的患者来说也不是一种理想的方法［3］。为了探讨手术前肠内营养的可行性，我们用胃镜法比较常规禁食组和3 h禁食组的胃液量和pH值，具体报告如下。 　　1 临床资料 　　1.1 一般资料 　　常规禁食组选取门诊健康体检患者（排除糖尿病、溃疡病、萎缩性胃炎、腹部手术、近期服用影响胃动力药物者入选），胃镜表现为慢性浅表性胃炎。本组15例，其中男5例，女10例。年龄20岁～58岁，平均年龄42.4岁。3 h禁食组选取因慢性胆囊炎、胆囊结石需住院行腹腔镜下胆囊切除的患者。排除标准同上，胃镜表现为慢性浅表性胃炎。本组15例，其中男5例，女10例。年龄31岁～70岁，平均年龄47.4岁。 　　　1.2 方法