床旁超声评估孕妇饱胃程度的研究

Assessment of full stomach by bedside ultrasound in parturients

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。

Abstract:

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 cm2 was 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 cross-sectional 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 assess-ment method.