外科急诊手术患者风险胃发生的相关因素研究  

Related factors to full stomach in patients undergoing emergency surgery

作　　者：闫鑫 胡慧聪 李靖 陆雅萍 YAN Xin;HU Huicong;LI Jing;LU Yaping(Graduate School,Zhejiang Chinese Medical University,Hangzhou 310053,China)

机构地区：[1]浙江中医药大学研究生院,杭州310053 [2]嘉兴市第一医院(嘉兴大学附属医院)麻醉与疼痛医学中心

出　　处：《浙江医学》2024年第8期840-844,850,共6页Zhejiang Medical Journal

基　　金：嘉兴市科技计划项目(2019AD32151);浙江省中医药创新团队(2022-19)。

摘　　要：目的通过超声测量胃窦部截面积(CSA)计算出胃内容物体积(GV),探索拟行急诊外科手术患者风险胃发生的相关因素。方法前瞻性选择2022年3月至2023年3月嘉兴市第一医院外科急诊就诊后拟行急诊手术患者190例,采用超声检查监测胃窦部图像,计算CSA、胃容积以及单位体重胃容量(GV/W),筛选风险胃患者;同时记录患者年龄、性别、BMI、禁食时间(FT)、发病-进食间隔时长(IT)、有无糖尿病、腹部手术史、发病部位、末次进食量、末次进食性质、末次进食肉类及发病后有无进食等因素,并分析各因素与风险胃发生的相关性。结果190例外科急诊患者中,检出风险胃患者51例(26.8%);风险胃患者中有糖尿病、IT>0 h(发病后有进食)及末次进食量≥400 mL的占比均高于非风险胃患者(均P<0.05);Pearson相关分析提示外科急诊患者GV/W与FT之间无相关性(r=-0.124,P>0.05)。结论胃窦超声检查能为判断外科急诊患者胃排空情况提供更加客观的依据,急诊手术患者术前不能单纯依靠FT评估是否饱胃,腹部疾病、糖尿病、末次进食量≥400 mL及发病后进食患者拟行急诊外科手术时风险胃发生率提高。Objective To calculate the gastric volume(GV)by measuring the gastric cross-sectional area(CSA)of gastric antrum with ultrasonography,and to explore factors related to preoperative risk stomach in patients undergoing emergency surgery.Methods A total of 190 patients who underwent emergency surgery in Jiaxing First Hospital from March 2022 to March 2023 were included in the study.The gastric cross-section area(CSA)was measured by ultrasonography before operation,the GV and gastric volume per unit weight(GV/W)were calculated.The age,gender,BMI,fasting time(FT),interval time between onset and eating(IT),diabetes,history of abdominal surgery,site of onset,last food intake,nature of last food intake,last meat consumption and eating after onset were documented.The factors related to preoperative full stomach were analyzed.Results Among 190 emergency surgical patients,51 cases(26.8%)had preoperative full stomach.Diabetes mellitus,IT>0 h(eating after onset)and last food intake≥400 mL were associated with the risk of full stomach in patients undergoing emergency surgery(all P<0.05).Pearson correlation analysis indicated that there was no significant correlation between GV/W and FT in emergency surgical patients(r=-0.124,P>0.05).Conclusion Gastric antrum ultrasonography can provide a more objective information of gastricemptying in patients with emergency surgery.It can not solely relied on fasting time to assess stomach fullness before emergency surgery.The study indicates that patients with abdominal diseases,diabetes,last food intake≥400 mL and patients who eating after onset have an increased incidence of risky stomach when they plan to undergo emergency surgery.

关 键 词：反流误吸 胃排空 超声 急诊 

分 类 号：R605.97[医药卫生—急诊医学]