床旁超声评估孕妇饱胃程度的研究  

Assessment of full stomach by bedside ultrasound in parturients

作　　者：刘小男[1] 王娜 曹俊[1] Liu Xiaonan;Wang Na;Cao Jun(Department of Anesthesiology,The First Affiliated Hospital of Chongqing Medical University)

机构地区：[1]重庆医科大学附属第一医院麻醉科,重庆400016

出　　处：《重庆医科大学学报》2022年第9期1100-1103,共4页Journal of Chongqing Medical University

基　　金：卫生部国家临床重点专科建设资助项目[编号:财社(2011)170号];重庆市卫计委医学科研资助项目(编号:2018MSXM145);重庆市卫健委资助项目(编号:2022WSJK117);重庆市医学重点学科资助项目[编号:渝卫科教(2007)2]。

摘　　要：目的:通过床旁超声评估拟行剖宫产足月孕妇饱胃程度,预测胃反流误吸风险。方法:选择孕龄≥36周拟行剖宫产的孕妇169例,入手术室即刻将其按照禁食时间<6 h与禁食时间≥6 h分为饱胃组及空胃组,采用床旁超声测定右侧卧位时胃窦长径、短径、横截面积。将右侧卧位横截面积>10.3 cm2定义为超声下饱胃者。同时记录其年龄、身高、体质量、孕周、禁食时间、最后一餐食物性质。结果:随着禁食时间延长,孕妇胃窦横截面积逐渐减小并趋于稳定。饱胃组与空胃组胃窦横截面积差异有统计学意义(P<0.05)。饱胃组46人,其中超声下判断饱胃者18人(39.13%),空胃者28人(60.87%);空胃组123人,其中超声下判断饱胃者1人(0.81%),空胃者122人(99.19%)。通过禁食时间和超声判断孕妇是否饱胃2种方法差异的Kappa系数为0.469(95%CI=0.341~0.643,P<0.001)。超声下空胃孕妇胃窦横截面积与年龄、孕周、身高、体质量、体质指数不相关(P>0.05)。结论:依据禁食时间判断孕妇的饱胃程度实际并不准确。对禁食时间<6 h的孕妇,床旁超声可减少不必要的临床干预,提高患者舒适性;对禁食时间≥6 h的孕妇,床旁超声可发现潜在饱胃患者,提高麻醉安全,是一种快捷、方便、可靠性强的新的饱胃评估手段。Objective:To assess the degree of full stomach of full-term parturients and predict the risk of gastric reflux and aspiration. Methods:A total of 169 full-term parturients with a gestational age of ≥ 36 weeks were selected and divided into two groups according to fasting time < 6 h as full stomach group and fasting time ≥ 6 h as empty stomach group. Bedside ultrasound was used to determine the long diameter,short diameter,and cross-sectional area of the gastric antrum in the right decubitus position at different time points. When the cross-sectional area of the right side decubitus > 10.3 cm2was defined as a full stomach under ultrasound. At the same time,their age,height,weight,gestational age,fasting time,and type of food eaten at the last meal were recorded. Results:With the prolongation of fasting time,the gastric antrum cross-sectional area of parturients gradually decreased and tended to be stable. There was statistical significance in gastric antrum cross-sectional area between full stomach group and empty stomach group(P <0.05). There were 46 parturients in full stomach group,including 18(39.13%) with full stomach under ultrasound and 28(60.87%) with empty stomach. Among 123 parturients in empty stomach group,1(0.81%) had full stomach under ultrasound and 122(99.19%) had empty stomach. The Kappa coefficient was 0.469(95%CI=0.341-0.643,P<0.001). The crosssectional area of gastric antrum of pregnant women with empty stomach under ultrasound was not correlated with age,gestational age,height,weight and BMI(P>0.05). Conclusion:It is not accurate to judge the degree of full stomach of parturients based on fasting time.For parturients with fasting time < 6 h,bedside ultrasound can reduce unnecessary clinical intervention and improve patient comfort.For parturients with fasting time ≥ 6 h,bedside ultrasound can detect potential satiety patients,improve the safety of anesthesia,and is a fast,convenient and reliable new gastric satiety assessment method.

关 键 词：床旁超声 孕妇 饱胃 

分 类 号：R451[医药卫生—治疗学]