合并不完全肠梗阻结肠癌手术患者术前床旁超声检查评估的围术期反流误吸风险研究  

Study on preoperative bedside ultrasonography-assessed perioperative reflux and aspiration risk in surgical colon cancer patients with incomplete intestinal obstruction

作　　者：段敬丹 刘英英 高瑞云 杨玲[2] Duan Jingdan;Liu Yingying;Gao Ruiyun;Yang Ling(Anesthesiology School,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学麻醉学院,太原030001 [2]山西医科大学第一医院麻醉科,太原030001

出　　处：《肿瘤研究与临床》2024年第2期122-127,共6页Cancer Research and Clinic

摘　　要：目的探讨结肠癌患者术前合并不完全肠梗阻与术前床旁超声检查评估的围术期反流误吸风险的相关性。方法前瞻性病例系列研究。前瞻性选取2020年3月至2022年1月于山西医科大学第一医院拟择期手术的300例结肠癌患者为研究对象。根据术前是否合并不完全肠梗阻将患者分为梗阻组和未梗阻组。患者术前均行胃窦部超声检查,测量右侧卧位胃窦横截面积,计算胃容积以及单位体质量胃容积(GV/W),均以M(Q_(1),Q_(3))表示。比较两组患者右侧卧位胃窦横截面积、胃容积和GV/W的差异及反流误吸风险(GV/W<0.8 ml/kg时风险极低,GV/W为0.8~1.5 ml/kg时风险低,GV/W>1.5 ml/kg时风险高)。采用多因素logistic回归分析反流误吸风险高的影响因素。结果300例患者中有7例因超声检查影像模糊被排除最终纳入293例,其中梗阻组146例,男性80例,女性66例,年龄[M(Q_(1),Q_(3))]58.0岁(55.0岁,67.0岁);未梗阻组147例,男性64例,女性83例,年龄55.0岁(53.5岁,64.0岁)。梗阻组患者年龄、体质量指数(BMI)均高于未梗阻组,差异均有统计学意义(均P<0.05);两组患者性别、禁饮食时间、合并高血压、合并糖尿病、吸烟情况、久坐及酗酒情况比较,差异均无统计学意义(均P>0.05)。梗阻组患者右侧卧位胃窦横截面积[5.83 cm^(2)(5.25 cm^(2),6.70 cm^(2))比5.13 cm^(2)(4.43 cm^(2),5.79 cm^(2)),P<0.001]、胃容积[43.00 ml(37.07 ml,52.74 ml)比32.78 ml(25.52 ml,39.85 ml),P<0.001]和GV/W[0.70 ml/kg(0.65 ml/kg,0.82 ml/kg)比0.55 ml/kg(0.46 ml/kg,0.62 ml/kg),P<0.001]均高于未梗阻组。梗阻组中反流误吸高风险患者比例高于未梗阻组[22.6%(33/146)比12.2%(18/147),χ^(2)=4.59,P=0.032]。多因素logistic回归分析显示,合并不完全肠梗阻(合并比未合并,OR=2.145,95%CI:1.096~4.198,P=0.026)、男性(女性比男性,OR=0.415,95%CI:0.199~0.867,P=0.019)是术前床旁超声检查评估的围术期反流误吸风险高的独立危险因素。结论结肠癌合并�Objective To investigate the correlation between preoperative incomplete intestinal obstruction and the risk of perioperative reflux and aspiration assessed by preoperative bedside ultrasonography in patients with colon cancer.Methods A prospective case series study was conducted.A total of 300 patients with colon cancer who underwent elective surgery from March 2020 to January 2022 in the First Hospital of Shanxi Medical University were prospectively selected for the study.According to whether there was incomplete intestinal obstruction before operation,the patients were divided into obstruction group and non-obstruction group.All patients underwent preoperative ultrasound examination of the gastric antrum,measuring the cross-sectional area of the gastric antrum in the right lateral position,and calculating the gastric volume and unit body mass gastric volume(GV/W),which were all expressed as M(Q_(1),Q_(3)).The differences in cross-sectional area of the gastric antrum,gastric volume and GV/W in the right lateral position between the two groups were compared,as well as the risk of reflux and aspiration(the risk of reflux and aspiration was extremely low at GV/W<0.8 ml/kg,the risk was low at GV/W 0.8-1.5 ml/kg,and the risk was high at GV/W>1.5 ml/kg).Multivariate logistic regression was used to analyze the influencing factors of high risk of reflux and aspiration.Results Of 300 patients,7 patients were excluded because of blurred images on ultrasonography,and a total of 293 patients were finally included.The age[M(Q_(1),Q_(3))]of obstruction group(146 cases)was 58.0 years old(55.0 years old,67.0 years old),including 80 males and 66 females;the age of non-obstruction group(147 cases)was 55.0 years old(53.5 years old,64.0 years old),including 64 males and 83 females.The age and body mass index(BMI)of the patients in the obstructin group were higher than those in the non-obstruction group,and the differences were statistically significant(both P<0.05),and there were no significant differences in gender,duration of di

关 键 词：结肠肿瘤 肠梗阻 胃排空 反流 胃 超声检查 

分 类 号：R735.35[医药卫生—肿瘤]