床边超声在危重患者胃容量监测中的应用价值

The value of bedside ultrasonographic measurement in predicting gastric content and volume of critically ill patients

目的探讨床边超声测量胃窦横切面面积(CSA)评估危重患者胃容量的可行性,为指导临床制定合理的肠内营养方案提供参考.方法①纳入接受肠内营养的危重患者15例,回抽胃内容物之前,采用床旁超声测量半卧位时患者胃窦单切面面积.对回抽量与胃窦CSA行Pearson相关性分析,并计算线性回归方程.②选取非胃肠道手术后患者19例,禁食禁饮至少8 h,取半卧位行床边超声检查,随后予患者胃内注入200 mL温水,观察空腹和充盈状态下胃窦CSA的变化.中位数法确定胃液体潴留的筛查阳性界值,通过Bouvet公式和Perlas公式计算胃容量GV1和GV2,筛选适合国人的胃液体容量计算公式.结果①胃内营养液回抽量与胃窦CSA呈正相关关系(r=0.907,P=0.000);线性回归分析显示回归方程为:Y=26.019X-108.825(F=60.374,P=0.000),有统计学意义.②胃内充盈200 mL液体时,胃窦CSA中位数为1075 mm^2.根据不同公式计算GV1、GV2分别为(189.89±22.59)mL和(183.11±180.37)mL,差异无统计学意义(P>0.05),但GV2的离散程度较GV1明显增大.结论床边超声测量胃窦CSA用于评估危重患者胃容量具有可行性,应用Bouvet计算公式更适合预测国人胃内液体容量.

Objective To assess the feasibility of bedside ultrasonography in measuring gastric antral cross-sectional area(CSA)of eritically ill patients and to predict gastric volume(GV)in order to provide reference for making reasonable enteral nutrition plan.Methods①15 critically ill patients requiring enteral nutrition were enrolled.The bedside ultrasonographic measurement was performed at semi-siting position before tube feed aspiration by nursing staff.The relationship between the gastric antral CSA and the volume of aspirated gastric contents was analyzed,and the linear regression equation was calculated.②19 patients with non-gastrointestinal surgery were enrolled,all of them fasted at least 8 hours and were injected 200 mL warm water,and the gastric antral CSA on the empty or full stomach were monitored by bedside ultrasonographic measurement.The median was used to validate the cutoff values for increased gastric fluid content.The stomach volume was calculated by the Bouvet formula(GV1)and the Perlas formula(GV2),and two methods were compared for screening the formula of gastric liquid capacity which was suitable for Chinese.Results①Gastric antral CSA determined by ultrasound correlated positively with aspirated enteral nutrition volume(r=0.907,P=0.000),and the linear regression equation was:Y=26.019X-108.825(F=60.374,P=0.000).②Gastric antral CSA of 1075 mm^2 was taken as cut-off value for the prediction of gastric fluid retention.According to the different formulas of gastric antral CSA,GVI and GV2 were calculated to be(189.89±22.59)mL and(183.11±180.37)ml,respectively.The difference was not statistically significant(P>0.05),but the dispersion of CV2 was higher than that of GV1.Conclusion The bedside ultrasonographie measurement for gastric antral CSA can be considered as available tools for the evaluation of enteral feeding in critically ill patients.This Bouvet formula is a good method to assess the gastrie fluid volume in Chinese people.