文章摘要
胃超声检查评估急诊剖宫产产妇胃排空的效果
Effect of gastric ultrasonography in assessing gastric emptying of patients undergoing emergency cesarean section
  
DOI：10.12089/jca.2019.04.015
中文关键词: 超声检查  胃内容物  产妇  误吸
英文关键词: Ultrasonography  Gastric content  Parturient  Aspiration
基金项目:
作者单位E-mail
黄丽君 310009,杭州市,浙江大学医学院附属第二医院麻醉科(现在浙江省宁波市鄞州人民医院麻醉科)  
严敏 310009,杭州市,浙江大学医学院附属第二医院麻醉科 zryanmin@zju.edu.cn 
张冯江 310009,杭州市,浙江大学医学院附属第二医院麻醉科  
周振锋 浙江省人民医院,杭州医学院附属人民医院麻醉科  
任秋生 浙江省宁波市鄞州人民医院麻醉科  
吴猛 浙江省宁波市鄞州人民医院超声科  
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中文摘要:
      
目的 通过胃窦超声检查，探讨胃超声检查评估急诊剖宫产产妇胃排空情况的效果，并分析影响产妇胃排空的危险因素。
方法 选择2017年7月至2018年5月行急诊剖宫产的产妇143例，孕龄≥36周，年龄≥18岁，ASA I或II级，BMI<35 kg/m2。产妇入室后，行胃内容物定性检查、胃窦Perlas评分及胃窦横截面积测量。根据产妇进食情况临床判断其胃排空情况。
结果 超声临床判断均为空腹2例（1.4%），超声判断空腹临床判断饱胃105例(73.4%)，超声判断饱胃临床判断空腹5例(3.5%)，超声临床判断均为饱胃31例(21.7%)。产妇最后一次进食脂肪或肉类食品（OR=372.725，95%CI 18.695～7430.921，P<0.001）、进食量偏大（OR=5.701，95%CI 2.268～14.332，P<0.001）是饱胃的危险因素，而进食至超声检查间隔长（OR=0.366，95%CI 0.201～0.666，P<0.001）是饱胃的保护因素。
结论 胃窦超声检查能为围术期判断产妇胃排空情况提供更加客观的依据，最后一次进食正餐种类、进食量以及进食至超声检查间隔可能影响产妇胃排空情况。
英文摘要:
      
Objective Investigate the effect of assessing the empty of gastric contents in patients undergoing emergency cesarean section through the qualitative and quantitative ultrasound assessment of the gastric antrum,judging the risk factors that affecting maternal gastric emptying.
Methods A total of 143 pregnant women who underwent emergency cesarean section from July 2017 to May 2018 were selected, who all met the standard of gestational age ≥ 36 weeks, age ≥ 18 years, ASA physical status Ⅰ or Ⅱ, BMI < 35 kg/m2. After the parturient entered the operating room, the qualitative examination of gastric contents, the gastric antrum score and the measurement of the cross-sectional area of the gastric antrum were performed. The gastric emptying was judged clinically according to the feeding condition of the puerpera.
Results Two of the patients exhibited an empty stomach by both two methods (1.4%), 105 exhibited an empty stomach by ultrasound but an full stomach by clinical judgment (73.4%), 5 exhibited an full stomach by ultrasound but an empty stomach clinically (3.5%), and 31 exhibited an full stomach by both two methods (21.7%). Meternal eating fat or meat foods(OR=372.725,95%CI 18.695 - 7430.921, P<0.001),eating too much(OR=5.701,95%CI 2.268 - 14.332,P<0.001) was a risk factor of full stomach,and the time interval from feeding to ultrasound examination(OR=0.366,95%CI 0.201 - 0.666,P<0.001) was a protective factor for gastric emptying.
Conclusion Bedside gastric ultrasound can reliably assess gastric emptying through the assessment of the gastric antrum in the perioperative period. The type and amount of last meal eaten, the time interval from feeding to ultrasound examination are the key factors that affect maternal gastric emptying results.
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