| 摘要: |
| ［摘要］ 目的 研究床旁胃窦超声用于评估门诊无痛消化内镜诊疗患者胃内容物及反流误吸风险的应用价值。方法 选择2021年11月至2022年3月在桂林医学院第二附属医院择期行无痛消化内镜诊疗患者616例，在无痛消化内镜检查前10 min行床旁胃窦超声检查。观察并记录胃内容物性质、Perlas胃窦分级、右侧卧位胃窦横截面积（RLD CSA）、预测胃容积等超声检查结果及麻醉方案改变情况，记录胃镜实际胃容积及胃镜发现饱胃情况。通过Pearson相关分析评估RLD CSA、预测胃容积与实际胃容积的相关性，通过受试者工作特征（ROC）曲线分析评估RLD CSA对饱胃的预测价值。结果 19例患者未获得典型胃窦超声图像，最终597例患者纳入统计分析。所有患者超声检查时间为（2.9±0.9）min；超声诊断饱胃患者42例（7.0%）。超声诊断饱胃患者均改变麻醉方案，其中4例患者延期，38例患者行普通胃镜检查。胃镜下发现实际饱胃患者31例，其中液体28例，固体3例。所有患者未发生反流误吸。Pearson相关分析显示，RLD CSA、预测胃容积与实际胃容积呈正相关（P<0.05）。ROC曲线分析结果显示，RLD CSA具有预测饱胃的应用价值［AUC(95%CI)=0.926(0.864～0.987)，P<0.001］，最佳截断值为7.87 cm2，对应的灵敏度和特异度分别为96.4%、78.6%。结论 床旁胃窦超声可用于评估门诊无痛消化内镜诊疗患者胃内容物及反流误吸风险，可行性强、准确性高，具有良好的临床应用价值。 |
| 关键词: 胃窦超声 无痛消化内镜 胃内容物 反流误吸 |
| DOI：10.3969/j.issn.1674-3806.2024.04.05 |
| 分类号:R 614 |
| 基金项目:广西医疗卫生适宜技术开发与推广应用项目（编号：S2020108）；桂林医学院中青年教职工科研能力提升项目（编号：2018glmcy095） |
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| A study on the application value of bedside gastric antrum ultrasound in assessing gastric contents in patients undergoing outpatient painless digestive endoscopy |
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ZHANG Xu1, LIANG Suzhen1, ZHOU Zhihu1, HUANG Liqiao1, LONG Yufang1, SHI Min1, YANG Tiande2
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1.Department of Anesthesiology, the Second Affiliated Hospital of Guilin Medical University, Guangxi 541199, China; 2.Department of Anesthesiology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
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| Abstract: |
| ［Abstract］ Objective To study the application value of bedside gastric antrum ultrasound in assessing the gastric contents and the risk of reflux and aspiration in patients undergoing outpatient painless digestive endoscopy. Methods A total of 616 patients undergoing elective painless digestive endoscopy for diagnosis and treatment in the Second Affiliated Hospital of Guilin Medical University from November 2021 to March 2022 were selected, and bedside gastric antrum ultrasound was performed on the patients 10 minutes before painless digestive endoscopy. Ultrasound examination results including the nature of gastric contents, Perlas gastric antrum grading, right lateral decubitus gastric antrum cross-sectional area(RLD CSA) and predicted gastric volume, and changes in anesthesia protocols were observed and recorded. The actual gastric volume aspirated during gastroscopy and the full stomach detected by gastroscopy were recorded. The correlations of RLD CSA and predicted gastric volume with actual gastric volume were assessed by using Pearson correlation analysis. The predictive value of RLD CSA for full stomach was assessed by receiver operating characteristic(ROC) curve analysis. Results Nineteen patients did not obtain typical ultrasound images of the gastric antrum, and 597 patients were included in statistical analysis. The ultrasound exmination time for all the patients was (2.9±0.9)minutes. Forty-two patients(7.0%) were diagnosed by ultrasound as having a full stomach. The anesthesia regimens of the patients diagnosed with full stomach by ultrasound were changed, among whom 4 patients were given delayed anesthesia and 38 patients underwent ordinary gastroscopy. Under gastroscopy, 31 patients were found to have actual full stomach, of whom 28 patients were found to have liquid full stomach and 3 patients were found to have solid full stomach. No reflux and aspiration occurred in all the patients. Pearson correlation analysis showed that RLD CSA and predicted gastric volume were positively correlated with actual gastric volume(P<0.05). The results of ROC curve analysis showed that RLD CSA had the application value of predicting full stomach［the area under the curve(AUC)(95%CI)=0.926(0.864-0.987), P<0.001］, and the optimal cut-off value was 7.87 cm2, and the corresponding sensitivity and specificity were 96.4% and 78.6%, respectively. Conclusion Bedside gastric antrum ultrasound can be used to assess the gastric contents and the risk of reflux and aspiration in patients undergoing outpatient painless digestive endoscopy. Bedside gastric antrum ultrasound is feasible and accurate, and has good clinical application value in assessing the gastric contents and the risk of reflux and aspiration in patients undergoing outpatient painless digestive endoscopy. |
| Key words: Gastric antrum ultrasound Painless digestive endoscopy Gastric contents Reflux and aspiration |
