以實證觀點探討嬰幼兒術前禁食時間之準則

Evidence-Based Practice of the Guidelines for Preoperative Fasting Time in Infants and Young Children

術前午夜禁食是為了確保手術時胃排空完全，減少麻醉後因嗆到導致吸入性肺炎，甚至死亡的合併症。長久以來嬰幼兒皆沿用成人術前午夜禁食準則，因禁食時間過久，導致臨床上常見口乾、哭鬧不安、血糖偏低等生、心理不適之反應，也造成家屬與醫療人員關係緊張。本文目的乃為瞭解嬰幼兒術前禁食時間長短之適當性，故運用Cochrane、PubMed、UpToDate、Medline等相關資料庫搜尋，但因相關文獻較少，自2000年到2010年6月發表之文獻中，共只搜尋到七篇相關的隨機控制對照研究，這些研究結果建議嬰幼兒術前禁食可採「2-4-6準則」，但有些情況則不適用於此準則，如肥胖、胃腸道疾病及須緊急手術者。未來仍需更多臨床實驗佐證，以提供臨床醫護人員決策之參考，且給予嬰幼兒具個別性與安全性的照護。

Fasting at midnight before surgery to ensure complete gastric emptying time has been shown to reduce the risk of complications, such as aspiration pneumonia, choking and even death after anesthesia. Conventionally, infants and young children usually followed adult’s guidelines of preoperative fasting at midnight. Increases of fasting time for infants and young children usually result in dry mouth, crying, anxiety, low blood sugar, and general discomfort, causing tension between family members and medical staff. The purpose of this paper is to identify appropriate guidelines for preoperative fasting time for infants and young children. Literatures were searched from Cochrane, PubMed, UpToDate, Medline databases from January 2000 to June 2010. There were seven randomized controlled trails and of the studies suggested that infants and young children can adopted the preoperative fasting, ?-4-6-8 rule?with the exception of obese patients and those with gastrointestinal diseases and patients requiring emergent surgery. More studies are needed so that sufficient evidences can be provided.