床旁超声测量胃窦、胃底横截面积变化对非肥胖女性全麻诱导期间胃充气敏感性的比较

Comparison of the changes of antrum and fundus cross-sectional area measured by bedside ultrasonography on gastric insufflation during general anesthesia in non-obese women

目的比较全麻诱导期非肥胖女性超声下胃窦、胃底横截面积(CSA)的变化,分析二者与胃充气以及术后恶心呕吐(PONV)的关系。方法择期行妇科腹腔镜手术患者46例,根据面罩正压通气过程中胃窦部"彗星尾征"的有无将患者分为阳性组和阴性组,记录两组通气180 s后血氧饱和度(SPO2)、呼气末CO2分压(PETCO2)、潮气量(TV),测量通气前后胃窦、胃底的上下径、前后径并计算各自的CSA;根据ROC曲线预测胃充气的胃窦、胃底CSA,并计算其敏感性及特异性;记录两组PONV的发生率。结果实际入组患者41例,阴性组13例,阳性组28例。两组通气后TV、胃底CSA的差异均有统计学意义(P<0.05);阳性组通气前后胃窦、胃底CSA的差异均有统计学意义(P<0.05);胃窦、胃底CSA的ROC曲线下面积(95%CI)分别为0.67、0.80,阈值分别为3.19 cm^2、24.90 cm^2,敏感性分别为0.93、0.93,特异性分别为0.39、0.69;两组术后PONV的发生率差异有统计学意义(P<0.05)。结论全麻诱导期20 cmH2O压力值面罩正压通气时,超声测量胃底CSA比胃窦CSA的变化更能反映由此引起的胃充气状态;正压通气导致的胃充气与年轻女性患者手术后恶心呕吐的发生有关。

Objective To compare the changes of antrum and fundus cross-sectional area(CSA) measured by bedside ultrasonography on gastric insufflation during anesthesia induction in non-obese female patients and analyze the relationships between these changes as well as postoperative nausea and vomiting (PONV). Methods Fourty-six patients scheduled for elective gynecological laparoscopic operations were enrolled in the study. The patients who appeared the comet-tail artifacts were defined as gastric insufflation positive group(GI+ group), while the ones without comet-tail artifacts were defined as gastric insufflation negative group(GI- group). Blood oxygen saturation(SPO2), end-expiratory partial pressure of CO2(PETCO2), tidal volume(TV) were recorded after 180 seconds ventilation in both groups. The longitudinal and anteroposterior diameters of gastric antrum and fundus were measured before and after facemask ventilation respectively and the corresponding CSA were calculated. The cutoff values of prediction of gastric insufflation were determined according to the ROC curve and the corresponding sensitivity and specificity were calculated. PONV of the two groups were also recorded. Results The analysis was based on the remaining 41 data sets actually. There were 13 patients in GI- group and 28 ones in GI+ group. Compared with GI- group, the changes of TV and fundus CSA in GI+ group had significantly differences(P<0.05);while compared with before mask ventilation, the changes of antrum and fundus CSA in both groups had significantly differences (P<0.05). The areas of antrum and fundus CSA under the ROC curve (95%CI) were 0.67 and 0.80, with cut-off value 3.19 cm2 and 24.90 cm2, sensitivity 0.93 and 0.93 and specificity 0.39 and 0.69, respectively. The incidence of PONV in GI+ group was higher than that in GI- group(P<0.05). Conclusions Changes of fundus CSA by ultrasonography might be superior to antrum CSA in gastric insufflation caused by 20 cmH2O peak airway pressure of facemask ventilation during anesthesia induction. Gastric insufflation caused by positive pressure ventilation is related with PONV for young female patients undergoing gynecological laparoscopic operation.