An Observational Study On The Effect Of Metoclopramide On Gastric Motivity In Emergency Trauma Patients Based On Gastric Ultrasound

Part Ⅰ Observe the effect of methoclopramide on gastric motility in healthy volunteersObjectiveBedside ultrasound was used to evaluate the normal gastric emptying of healthy adults drinking milk and the gastric prokinetic effect of metoclopramide in healthy volunteersMethodsFourteen volunteers were divided into pure milk group（P group）and pure milk+metoclopramide group（PM group）.P group:drink 250ml pure milk;PM group:drink250ml pure milk and inject 10 mg metoclopramide intravenously.After abstaining fasting and drinking,the volunteers in both groups were placed in the supine position first,and then on the right side.During the measurement,the qualitative assessment of the gastric antrum was performed first and then the gastric antrum CSA measurement was performed.After the gastric empfication was confirmed by ultrasound,250ml milk was drunk within 5 minutes in group P,and 10 mg metoclopramide was intravenously injected after drinking 250ml milk within 5 minutes in group PM.And then CSA was measured using a standard convex ultrasonic probe（denoted as T₀）,the measurement was repeated three times for an average value.Ultrasound examination and measurement of gastric antrum were performed again at 30,60,90,and 120 minutes after drinking(denoted as T₃₀,T₆₀,T₉₀,and T₁₂₀,respectively),after that they were told not to drink or eat anything for the next 2 hours.The Gastric antrum CSA,Gastric emptying rate（GER）,minute of gastric emptying rate（GER/min）,properties of gastric contents and Perlas Grading were evaluated in different time periods of the two groups.ResultsIn healthy volunteers,there was significantly difference all the time in gastric antrum CSA and GV between the two groups.The gastric antrum CSA and GV in the PM group were less than those in the P group,and the difference was the largest between the two groups at 60 minutes.There was significantly difference all the time in GER and GER/min between the two groups,the GER and GER/min in the PM group were larger than those in the P group,and the largest difference between the two groups was at 30 minutes.Compared with P group,both of the change trend of gastric contents property（Solid-liquid-empty）and Perlas Grading in PM group was increased.CONCLUSIONSMetoclopramide can accelerate gastric emptying of healthy volunteers with a quick onset,and the effect is significant within 60 minutes after the injection,which significantly reduces the gastric volume.Part Ⅱ Effect of meoclopramide on gastric emptying in emergency trauma patientsObjectiveTo evaluate the gastric prokinetic effect of metoclopramide in emergency trauma patients by bedside ultrasound,and to explore the rationality,effectiveness and timing of metoclopramide in preoperative management of trauma satiety patients,so as to provide a way of thinking for the preparation before anesthesia of similar patients.MethodsUltrasound examination was performed immediately after the trauma patient was admitted to the emergency department of our hospital.The patients were placed in supine position first,and then a semi-sitting position（bedside elevation of 45°）.During the measurement,the gastric antrum was first qualitatively assessed first,and then the gastric antrum CSA was measured.All patients who met the criteria of intake and also satisfy gastric antrum CSA>5.5cm²were randomly divided into metoclopramide group（M group,n=25）and normal saline group（S group,n=25）.M group was given 10 mg metoclopramide intravenously,and S group was given 1 m L0.9%sodium chloride intravenously.Both groups were told to abstain fasting and drink before surgery.The first measurement of gastric antral CSA was denoted as T₀,and the measurements were repeated for the next 30,60,90,and 120 minutes(denoted as T₃₀,T₆₀,T₉₀,and T₁₂₀,respectively).In the two groups,The Gastric antrum CSA、GV、GER、GER/min、Gastric contents properties and Perlas grading of the two groups at different time periods,Gastric volume（GV）and Gastric volume/weight（GV/W）of T₁₂₀were evaluated.Risk of vomiting,regurgitation and aspiration,and management of anesthesia were assessed.ResultsIn patients with emergency trauma,there were statistically significant differences in gastric antrum CSA and GV between the two groups.The gastric antrum CSA and GV in the M group were less than those in the S group,and the difference was the largest between the two groups at 30 minutes.There were statistically significant differences in GER and GER/min between the two groups all the time.The GER of group M was greater than that of group S,and the difference was the largest between the two groups at 30 minutes.There was no significant change trend in the properties of gastric contents between the two groups and the difference was not statistically significant.The Perlas Grading did not change significantly,and the difference was not statistically significant.There were statistically significant differences in GV and GV/W at T₁₂₀between the two groups.The risk of T₁₂₀reflux aspiration was compared between the two groups,and the difference was statistically significant.CONCLUSIONSMetoclopramide can accelerate gastric emptying to a certain extent in patients with full stomach after emergency trauma in the first 30 minutes,reducing the high risk of reflux aspiration,but it still fails to reach the normal gastric emptying level,which may be related to delayed gastric emptying after trauma.