文章摘要
胃超声在急诊剖宫产产妇全麻术中的应用
Application of gastric ultrasound in puerpera for general anesthesia during emergency cesarean section
  
DOI：10.12089/jca.2021.11.007
中文关键词: 剖宫产术  喉罩全麻  胃－食管反流  术后恶心、呕吐  超声检查
英文关键词: Caesarean section  General anesthesia with laryngeal mask  Gastroesophageal reflux  Postoperative nausea and vomiting  Ultrasonography
基金项目:泉州市科技计划资助项目基金（2018N082S）
作者单位E-mail
沈龙源 362000,福建省泉州市,泉州市妇幼保健院·儿童医院麻醉科  
谢文钦 福建医科大学附属泉州市第一医院麻醉科 xiewenqin9@126.com 
肖全胜 362000,福建省泉州市,泉州市妇幼保健院·儿童医院麻醉科  
吴建文 362000,福建省泉州市,泉州市妇幼保健院·儿童医院麻醉科  
江秋霞 362000,福建省泉州市,泉州市妇幼保健院·儿童医院超声科  
罗琪琛 362000,福建省泉州市,泉州市妇幼保健院·儿童医院麻醉科  
许艺彬 362000,福建省泉州市,泉州市妇幼保健院·儿童医院麻醉科  
沈龙德 福建医科大学附属泉州市第一医院麻醉科妇产科  
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中文摘要:
      
目的 评价胃超声在预测急诊剖宫产术喉罩全麻产妇术中反流及术后24 h恶心、呕吐发生率的价值。
方法 选择需行急诊剖宫产术产妇309例，年龄19～42岁，ASA Ⅱ或Ⅲ 级。所有产妇入室时胃超声图像表现为均匀一致的低回声。入室时超声测量胃窦部横截面积（CSA），将产妇分为三组：387 mm2≤CSA＜505 mm2组（S组，n=98）；505 mm2≤CSA≤608 mm2组（M组，n=112）；CSA>608 mm2组（L组，n=99）。记录入室时、诱导后即刻、切皮时、胎儿娩出时、关腹时、拔除喉罩时食管中上段pH变化及反流发生情况。记录产妇胃管吸引量，入室时和麻醉结束时胃窦部CSA，并分析入室时胃窦部CSA与胃管吸引量的相关性。记录术后24 h内产妇恶心、呕吐的发生情况。
结果 S组和M组食管中上段pH均大于4.00，未出现术中反流病例；L组有4例（4%）于术者按压上腹部协助胎儿娩出时出现食管中上段反流，反流发生率明显高于S组、M组（P<0.05）。M组和L组胃管吸引量和不同时点胃窦部CSA明显大于S组（P<0.05），L组明显大于M组（P<0.05）。入室时胃窦部CSA与胃管吸引量呈明显的正相关（r=0.88 P <0.001）。术后24 h L组呕吐发生率明显高于S组和M组（P<0.05）。三组恶心发生率差异无统计学意义。
结论 在严格选择胃超声图像表现为均匀一致低回声病例及术中严密监测的前提下，Supreme双腔喉罩用于胃窦部CSA≤608 mm2急诊剖宫产术产妇术中并未观察到食管中上段反流；而胃窦部CSA>608 mm2时术中发生反流的风险及术后24 h呕吐发生率明显升高，应用时需谨慎。
英文摘要:
      
Objective To evaluate the value of gastric ultrasound in predicting the incidence of intraoperative reflux and 24 hours postoperative nausea and vomiting in patients with laryngeal mask airway for general anesthesia during emergency cesarean section.
Methods A total of 309 patients aged 19-42 years, ASA physical status Ⅱ or Ⅲ, whose gastric ultrasound showed uniform and consistent hypoechoic images when entering the operating room underwent emergency cesarean section. The patients were divided into three groups according to their preoperative antral cross-sectional areas (CSA): group S (387 mm2 ≤ CSA < 505 mm2, n = 98); group M (505 mm2 ≤ CSA ≤ 608 mm2, n = 112) and group L (CSA > 608 mm2, n = 99). The pH electrode probe was placed in esophagus between the middle and upper third during the operation. Local pH was continuously monitored. Anesthesiologist measured the antral cross-sectional area again by ultrasound at the end of anesthesia. Upon entering the operating room, immediately after induction, beginning of surgery, delivery of the fetus, closure of the abdomen, and removal of the laryngeal mask, the pH value of the middle and upper esophageal probe was measured and recorded. The gastric tube suction volume, gastric antrum CSA at entering the operating room and at the end of anesthesia were recorded, the correlation between gastric antrum CSA at entering the operating room and gastric tube suction volume were analyzed. The occurrence of nausea and vomiting was recorded within 24 hours after operation.
Results The pH values of the middle and upper esophagus in group S and group M were all greater than 4.00, and no case had intraoperative gastroesophageal reflux. In group L, 4 patients (4%) developed middle and upper gastroesophageal regurgitation when the operator pressed the upper abdomen to assist the delivery of the fetus, so the incidence of reflux in group L was significantly higher than that both in group S and group M (P < 0.05). Gastric tube suction and gastric antrum CSA in group M and group L were significantly higher than those in group S at different time points (P < 0.05), and those in group L were significantly higher than those in group M (P < 0.05). There was a significant positive correlation between gastric antrum CSA and gastric tube suction volume (r = 0.88 P <0.001). The incidence of vomiting in group L was higher than that in group S and group M 24 hours after operation (P < 0.05). There was no significant difference in the incidence of nausea among the three groups.
Conclusion In a carefully selected patients whose gastric ultrasound showed uniform and consistent hypoechoic images, the Supreme laryngeal mask was used in patients with a gastric antrum CSA ≤ 608 mm2 during emergency cesarean section, and no middle and upper gastroesophageal reflux was observed. However, the risk of intraoperative reflux and the incidence of postoperative vomiting within 24 hours were significantly increased when the gastric antrum CSA >608 mm2, which should be carefully used.
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