医周一句 | 其实,术前不用一律禁食 8 小时!

摘要: 真的!

12-11 07:13 首页 丁香园


这是丁香园「医周一句 · Clinical Pearls」栏目的第 9 期。今天我们要讨论的是术前禁食的问题。


在我们刚进入临床的时候,老师都告诉我们:「术前八小时不吃不喝」,在欧美麻醉医师口中,也是「nothing by mouth for 8 hours」。


但是,不适当的禁食禁水时间,极有可能增加患者口渴、饥饿等不适感,甚至是低血糖或脱水。


2017 年 1 月 3 日,美国麻醉医师学会(ASA)最新版的《健康患者择期手术前禁食及降低误吸风险的药物使用实践指南》就告诉我们,术前禁食不用一律 8 小时。


Clear liquids may be ingested for up to 2 h before procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia.These liquids should not include alcohol.


Breast milk may be ingested for up to 4 h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia.


Infant formula may be ingested for up to 6 h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia.


A light meal or nonhuman milk may be ingested for up to 6 h before elective procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia.


Additional fasting time (8 or more hours) may be needed in cases of patient intake of fried foods, fatty foods, or meat.


也就是说,不同的食物,禁食时间不同。用一张表格表述如下:



这里需要注意的是,「清饮料」包括清水、糖水、无渣果汁、碳酸类饮料、清茶及黑咖啡(不加奶),但不包括含酒精类饮品;牛奶等乳制品的胃排空时间与固体食物相当,需要按照固体食物的禁食时间,但母乳排空时间更短。


而且,本指南适用于在麻醉或镇静下接受择期手术的所有年龄段的健康患者。


胃内容物排空功能受影响的患者,不能简单按照这张表来禁食,如孕妇、肥胖、糖尿病、食管裂孔疝、胃食管反流病、肠梗阻、急诊手术或胃肠外营养的患者。


Clinical Pearls 001  急性脑卒中病人头部体位怎么摆?

Clinical Pearls 002  长期抗小板治疗需要同时服用 PPI 吗?

Clinical Pearls 003  长期服用 PPI 安全吗?

Clinical Pearls 004  维 A 酸真的能除皱吗?

Clinical Pearls 005  适度饮酒对大脑有益还是有害?

Clinical Pearls 006  如何避免过度检查?

Clinical Pearls 007 太高兴竟然也会「心碎」?

Clinical Pearls 008   读书竟然可以长寿!


音频作者:yoyo 

责任编辑:shamouer

参考文献:

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: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration.Anesthesiology. 2017 Mar;126(3):376-393. doi: 10.1097/ALN.0000000000001452.


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