超声测量胃液量用于急诊手术患者呕吐发生的预测
Ultrasound measurements of the amount of juice for prediction of the risk of occurrence of vomit during emergency surgery
目的 在非创伤条件下，利用超声测量胃窦部横截面积（cross-sectional area，CSA）并计算胃液量，预测呕吐发生情况。 方法 (1)患者取半卧位，使用超声系统，腹部成像模式，换能器C60x/5-2MHz凸阵探头，扫描上腹部（剑突下）旁矢状平面，以肝左叶、腹主动脉作为体内标志物，顺时针或逆时针轻微旋转探头，以获得清晰的胃窦图像。在超声图像中测量胃窦部沿身体头尾方向及前后方向的最大直径（D1和D2），计算CSA，即CSA=π×D1×D2/4。收集87例急诊手术患者的胃窦部CSA并根据Bouvet回归方程计算胃液量。(2)为进一步判断超声测量胃窦部CSA计算胃液量对呕吐的预测，另收集113例急诊手术患者胃窦部CSA并计算胃液量，按胃液量将患者分为3组：A组：胃液量≤0.4ml/㎏；B组：0.4ml/㎏<胃液量≤0.8ml/㎏；C组：胃液量＞0.8 ml/kg。 结果 超声测量患者胃窦部CSA具有可行性；急诊手术进行麻醉诱导前测量的胃窦部CSA与胃液体积存在正相关，且胃窦部CSA可用于判断围手术期呕吐发生的机率；呕吐误吸危险性标准为胃液残留量>0.8 ml/kg。 结论 利用超声测量胃窦横截面积（CSA）并计算胃液量，以此来预测呕吐发生是可行的，有望在今后应用于急诊手术中。
Objective To explore the use of ultrasound in measuring antral cross-sectional area (CSA) and calculating the amount of gastric juice in non-traumatic conditions, for predicting the occurrence of vomiting. Methods Patients were placed in semi-recumbent position. An ultrasound system with an abdominal imaging mode and a transducer C60x /5-2MHz convex array probe was employed to scan the abdomen (xiphoid) around the sagittal plane. The left lobe of the liver and the abdominal aorta were used as the body markers. The probe was rotated slightly clockwise or counterclockwise to obtain a clear picture of the gastric antrum. gastric antrum was measured for the maximal diameter (D1 and D2) in the ultrasound image in a sagittal and vertical direction, and CSA was then calculated (CSA = π × D1 × D2/4). The amount of gastric juice was calculated based on Bouvet regression equation. All the patients were divided into three groups according to the amount of juice: A: gastric volume ≤0.4ml/kg; group B: 0.4ml/ kg < juice volume ≤0.8ml/kg; group C: gastric volume> 0.8 ml/kg. Results (1) The feasibility using ultrasound for measurement of antrum CSA was confirmed. (2) A positive correlation between CSA and volume of gastric antrum could be found in ultrasound measurement before induction of anesthesia. (3) Ultrasound measurements of gastric antrum and CSA in emergency surgery before induction of anesthesia can be used to determine the probability of peri-operative vomiting. (4) Gastric residual volume greater than 0.8ml/kg could be used as an indication of a high possibility of occurrence of peri-operative vomitting. Conclusion Ultrasound can be used for measurement of antral cross-sectional area (CSA) and calculation of the amount of gastric juice; it is feasible to predict vomiting, and can be expected to be used in future emergency surgery.
Gastric juice volume / Vomiting / Ultrasound measurements / Emergency surgery
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