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术前禁食:您可以进食和饮用的内容及其原因

为何麻醉前必须停止进食、何时仍可少量饮水,以及未禁食可能导致的后果。确保手术期间胃部排空和肺部安全的明确禁食规则。

Updated May 2026
手术前禁食的示意图:时钟旁放着一个空盘子和一个空玻璃杯。
麻醉前禁食:按照建议的时间,禁止进食或饮水。 Kieran Hirpara 4.0

本页面由机器翻译,尚未经临床医生审核。英文版本为权威版本。

手术当天,有两件事对您的安全最为重要:您接受的麻醉类型,以及您严格遵循所给予您的禁食指示的程度。

为什么要求您禁食

全身麻醉会使通常阻止胃内容物反流至咽喉的肌肉松弛。如果您的胃是满的,这些物质可能会在您失去意识时溢出到肺部,这是非常严重的。禁食可以排空胃部,使这种情况极不可能发生。标准规则如下:

  • 从您手术详情邮件中规定的禁食时间起,禁止进食或饮水。 禁止食物、牛奶、水、茶或咖啡、糖果或口香糖。该时间是根据您的入院时间计算的:通常是入院前七小时,或者如果您在清晨入院,则为午夜。
  • 如果您正在使用注射型糖尿病或减肥药物(Ozempic、Wegovy、Mounjaro、Trulicity、Byetta),请继续服用,但您的禁食时间为手术时间前 24 小时。这些药物会减缓胃排空,因此常规的禁食时间是不够的。
  • 如果您的手术仅在局部麻醉下进行,您的邮件将说明您无需禁食。

如果您早晨服用常规的降压药或抗癫痫药,除非麻醉师另有指示,否则请用一小口水送服。手术当天早晨不服用糖尿病药片;阿司匹林和氯吡格雷继续服用,而华法林等抗凝药需在术前 48 小时停止;blood thinners 和 preparing for surgery 页面有详细资料。

我们使用的麻醉类型

大多数上肢手术采用以下三种麻醉方式之一,有时也会联合使用:

  • 全身麻醉: 您处于完全睡眠状态。麻醉医生通过您手背上的小型静脉输液通道让您入睡,并在整个过程中全程监护。
  • 区域阻滞: 将局部麻醉药注射到颈部或腋窝的神经周围,使整条手臂在数小时内失去知觉。您也可能接受镇静治疗,以便在手术期间入睡,但您不会使用呼吸机。
  • 局部麻醉: 小型手术(如扳机指松解术)通常可以在局部麻醉且您完全清醒的情况下进行,有时辅以轻度镇静。

您的麻醉医生将在手术当天与您讨论这些选项。具体选择取决于手术类型、您的整体健康状况以及您的个人偏好。

手术当日须知

您需在预定手术时间前 1–2 小时到达。护士将核查您的禁食情况,建立静脉输液通路,并签署最终知情同意书。麻醉医生将在您进入手术室前亲自与您见面。

手术后,您将在复苏区苏醒。如果您接受了区域阻滞麻醉,手臂会感觉沉重且麻木;这是正常现象,持续时间为 8–24 小时。保护麻木的手臂: 将其保持在悬吊带中,不要倚靠该手臂,并注意保暖。感觉会逐渐恢复,常伴有针刺感。

术后最初几小时内,恶心、嗜睡以及咽喉疼痛(由呼吸管引起)较为常见。请缓慢饮水,清淡饮食,并充分休息。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您做出自身治疗决策所需的深度。麻醉部分值得额外阅读,因为患者最希望获得保证的两件事——神经阻滞导致的神经损伤,以及“清醒”状态是否比“睡眠”状态更安全——都有可靠的数据支持,且两者的答案均与直觉相悖。

神经阻滞导致持续性神经问题的风险

几乎所有接受上肢手术的患者都会被提供神经阻滞,而几乎所有人都会询问针头是否会损伤神经。这是一个合理的问题,而诚实的回答需要做出区分:暂时性的感觉异常并不罕见,但永久性损伤则较为少见。

一项纳入 12,532 名患者的系统综述考察了上肢手术区域麻醉术后的神经系统症状,其核心观点虽属方法论层面,但对您而言至关重要:总体风险因测量方式不同而呈现显著差异 [1]。在前瞻性评估的随机对照试验中,由于有人主动询问每一位患者,报告的发病率远高于回顾性系列研究,后者仅统计那些抱怨得足够大声的患者 [1]。

实际解读:如果某项研究向您引用了一个非常低的数值,请询问是否有人主动进行了排查。那些能够自行缓解的症状足够常见,因此应被描述为预期情况,而非并发症;而那些持续存在的症状则确实较为罕见。

清醒并非自动更安全

患者乃至非患者群体中普遍存在一种观念,认为避免全身麻醉必然更安全,尤其是在老年人中,且尤其关乎术后的意识混乱问题。

对此最直接的检验来自髋部骨折手术,由于患者高龄且体弱,该问题已在此领域进行了大规模研究。汇总 3,736 名患者的数据显示,与全身麻醉相比,区域麻醉 并未 显著降低术后谵妄或死亡率 [2]。

这是一个真正令人惊讶的结果,其解读需谨慎。这并不意味着麻醉方式的选择无关紧要,而是意味着该选择应基于患者的心脏、肺部、气道具体情况以及计划实施的手术,而非基于某一类别更安全的一般性信念。对于健康患者而言,现代全身麻醉非常安全,而神经阻滞并非免死金牌。

神经阻滞真正发挥价值的场景

区域麻醉最有力的论据并非安全性,而是疼痛控制。一项针对 1,872 例接受肱骨近端骨折手术修复患者的系统综述得出结论:区域麻醉是术后镇痛的良好选择 [3],肩部手术后的最初几个小时疼痛最为剧烈,而神经阻滞恰好能覆盖这一时段。

此外,实施方法也并非只有一种。针对肩关节镜手术,一项纳入 1,382 例患者的综述发现,肩胛上神经阻滞在疼痛控制方面 并不 优于臂丛肌间沟阻滞,但其副作用谱更为有利 [4]。臂丛肌间沟阻滞会可靠地导致上肢暂时性肌力减弱,并可能影响膈神经,若患者呼吸功能本已处于临界状态,这一点尤为关键。在此类情况下,选择另一种阻滞方式并非妥协,而是更符合该特定手术需求的优选方案。

为何禁食规定如此

禁食只有一个原因:麻醉后的气道无法自我保护,因此反流的胃内容物可能误吸入肺部。这一事件虽罕见但后果严重,而禁食规则正是针对它的低成本保险。

常见的错误是将“禁食”视为一种竞赛。延长禁食时间并不会增加安全性,而带着脱水状态到达医院只会让你感觉更糟,使静脉置管更困难,且对胃部毫无益处。清流质确实比食物更快离开胃部,部分医院允许在术前更近的时间摄入。我们要求术前七小时不进食也不饮水,仅此一次、仅此一条规则,出于实际原因:手术排程有时会提前,而严格保持完全禁食的患者可被提前安排至更早的手术时段,而非被动等待。请勿早于规定时间开始禁食:额外的禁食时间除了增加口渴感外毫无益处。若手术当日出现延迟,请主动询问,而非基于“禁食越久越好”的假设,在极度口渴中静坐等待。

参考文献

[1] Albaum JM, Abdallah FW, Ahmed MM, Siddiqui U, Brull R. 上肢手术后区域麻醉后神经症状的风险是多少?随机试验的系统评价和荟萃分析。Clin Orthop Relat Res. 2022;480(12):2374-89. https://doi.org/10.1097/CORR.0000000000002367

[2] Zhou S, Zhang S, Si H, Shen B. 老年患者髋部骨折手术中区域麻醉与全身麻醉:系统评价和荟萃分析。J Orthop Surg Res. 2023;18(1). https://doi.org/10.1186/s13018-023-03903-5

[3] Iliaens J, Metsemakers W, Coppens S, Hoekstra H, Sermon A, Van de Velde M, et al. 肱骨近端骨折手术修复的区域麻醉:系统评价。Arch Orthop Trauma Surg. 2019;139(12):1731-41. https://doi.org/10.1007/s00402-019-03253-0

[4] Kay J, Memon M, Hu T, Simunovic N, Duong A, Paul J, et al. 肩胛上神经阻滞用于关节镜肩关节术后疼痛控制:系统评价和荟萃分析。Orthop J Sports Med. 2018;6(12). https://doi.org/10.1177/2325967118815859


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