即时胃窦部超声在小儿急诊手术误吸风险评估中的应用  

Application of Gastric Antrum Ultrasound in Assessing the Aspiration Risk during Pediatric Emergency Surgery

作　　者：汪威廉 龚洁 肖锦亮 张畅 李圣平[1] WANG Weilian;GONG Jie;XIAO Jinliang;ZHANG Chang;LI Shengping(Dept.of Anesthesiology,Jingzhou Hospital Affiliated to Yangtze University,Jingzhou Hubei 434020,China;Dept.of Pain Treatment,Jingzhou Central Hospital,Jingzhou Hospital Affiliated to Yangtze University,Jingzhou Hubei 434020,China)

机构地区：[1]荆州市中心医院/长江大学附属荆州医院麻醉科,湖北荆州434020 [2]荆州市中心医院/长江大学附属荆州医院疼痛科,湖北荆州434020

出　　处：《昆明医科大学学报》2023年第11期145-151,共7页Journal of Kunming Medical University

基　　金：荆州市科技局科研基金资助项目(2021HC12)。

摘　　要：目的探讨即时胃窦部超声检查在小儿急诊手术误吸风险评估中的应用。方法选择湖北省荆州市中心医院2020年12月至2021年12月的急诊小儿手术120例,年龄1~12岁,ASA分级Ⅰ~Ⅲ级,拟行外科手术治疗,首先根据是否符合美国麻醉医师协会2017年发布的禁饮禁食指南,对患儿进行临床胃排空评估,将患儿分为临床空腹(CE组)和临床饱胃(CF组),然后利用迈瑞M7超声,对小儿胃窦部进行胃内容物的定性和定量评估,将患儿分为超声空腹(UE组)和超声饱胃(UF组),记录临床和超声2种评估方法的一致性。检测右侧卧位下小儿胃管吸引前和吸引后胃窦部横截面积(cross-sectional area,CSA),记录胃管吸引前后CSA的变化,术前小儿的进食种类和进食量,进食与超声检查之间的时间间隔。结果最终纳入108例小儿进行了统计分析,临床和超声判断胃排空结果一致性较差,超声和临床均判断为空腹92例(85.2%),超声判断空腹,临床判断饱胃4例(3.7%),超声判断饱胃,临床判断空腹9例(8.3%),超声和临床均判断为饱胃3例(2.8%),(kappa=0.255,P=0.006)。患儿胃管吸引前的进食量与胃窦部CSA存在较好相关性(r=0.840,P<0.05)。吸引前UF组患儿胃窦部CSA明显大于UE组(P<0.05),吸引后UF组患儿胃窦部CSA与UE组无明显差异(P=0.324)。UF组患儿进食以配方奶和高脂肪食物居多,且胃管吸引量,进食量多于UE组(P<0.05),UF组患儿超声检查间隔时间短于UE组(P<0.05)。2组患儿术后呕吐的发生率分别为8.3%和5.2%,差异无统计学意义(P=0.674)。结论急诊手术患儿术前行即时胃窦部超声检查结合患儿的进食种类和进食量,可以有效帮助麻醉医师在紧急情况下做出是否饱胃的判断,以便及时调整麻醉策略,选择合适的气道管理方式。Objective To investigate the application of point-of-care gastric antrum ultrasonography in the risk assessment of aspiration in children undergoing emergency surgery.Methods A total of 120 cases of pediatric emergency surgery in Jingzhou Central Hospital of Hubei Province from December 2020 to December 2021,aged 1-12 years,American Society of Anesthesiologists physical status I-III,scheduled for surgical treatment,were selected.First,according to whether it met the fasting guidelines issued by the American Society of Anesthesiologists in 2017,the clinical gastric emptying of the children were evaluated.The children were divided into clinical fasting group(CE group)and clinical full group(CF group),and then Mindray M7 ultrasound was used to qualitatively and quantitatively evaluate the gastric contents in the gastric antrum.The children were divided into ultrasound empty group(UE group)and ultrasound full group(UF group),and the consistency of clinical and ultrasound evaluation methods was recorded.The cross-sectional area(CSA)of the gastric antrum was measured before and after gastric tube suction in children in the right lateral position.The changes of CSA before and after gastric tube suction,the type and amount of food eaten before surgery,and the time interval between eating and ultrasound examination were recorded.Results A total of 108 children were finally included for statistical analysis.The consistency between clinical and ultrasound examination was poor,92 cases(85.2%)were judged as fasting by both ultrasound and clinical.4 cases(3.7%)were judged as fasting by ultrasound but full stomach by clinical examination.9 cases(8.3%)were judged as full stomach by ultrasound but fasting by clinical examination.3 cases(2.8%)were judged as full stomach by both ultrasound and clinical,(kappa=0.255,P=0.006).There was a well correlation between food intake and CSA in gastric antrum before gastric tube aspiration(r=0.840,P<0.05).Before aspiration,the gastric antrum CSA in the UF group was significantly larger than th

关 键 词：胃窦部超声检查 小儿急诊 误吸 禁饮禁食 

分 类 号：R614[医药卫生—麻醉学]