急诊手术患者术前饱胃的危险因素

Risk factors for preoperative full stomach in patients undergoing emergency surgery

目的筛选急诊手术患者术前饱胃的危险因素。方法选择急诊手术患者,年龄≥18岁,ASA分级Ⅰ~Ⅲ级,BMI≥15 kg/m^2,性别不限。术床调至头高足低30°,右侧卧位下采用胃窦部超声图像,分别予定性和定量评估超声图像。前者为定性评估胃窦内为空窦,有液体或固体;后者于胃窦舒张期取3次图像,分别测量图像最长径线(D1)和最宽径线(D2),测量3次取平均值,计算胃窦横截面积[CSA=(D1×D2×π)÷4]。计算胃容积[GV=27.0+(14.6×CSA)-(1.28×年龄)],结果<0时,胃容量为0。计算GV/体重,≤1.5 ml/kg时为空胃,胃内容物为固体或GV/体重>1.5 ml/kg为饱胃。根据患者是否饱胃,将其分为2组:空胃组(E组)和饱胃组(F组)。记录患者禁食水时间、并存疾病及手术类型。将组间比较差异有统计学意义的指标行多元逻辑回归分析,筛选急诊手术患者术前饱胃的危险因素。结果最终纳入179例,其中E组患者121例,F组58例。与E组比较,F组患者禁食水时间<6 h及并存糖尿病的发生率升高(P<0.05)。并存糖尿病是急诊手术患者术前饱胃的独立危险因素(P<0.05),OR值及其95%CI分别为11.968(2.392~59.870)。结论并存糖尿病是急诊手术患者术前饱胃的独立危险因素。

Objective To identify the risk factors for preoperative full stomach in the patients undergoing emergency surgery.Methods American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes,aged ≥18 yr,with body mass index≥15 kg/m^2,scheduled for elective emergency surgery,were included.The operation bed was adjusted to 30° head-high and feet-low position.Ultrasound images of gastric antrum were observed in the right decubitus position,and the ultrasonic images were evaluated qualitatively and quantitatively.The ultrasonic image was qualitatively assessed as having empty antrum,liquid or solid.Three images were obtained during the diastolic period of gastric antrum when quantitative assessment was performed.The longest diameter(D1)and the widest diameter(D2)of the images were measured three times and averaged to calculate the cross-sectional area of gastric antrum[CSA=(D1×D2×π)/4].The gastric volume was calculated[GV=27.0+(14.6×CSA)-(1.28×age)].When the result was<0,the gastric volume was 0.GV/body weight was calculated,and GV/body≤1.5 ml/kg was considered as empty stomach.When gastric content was solid or GV/body weight>1.5 ml/kg,it was considered as full stomach.Patients were divided into 2 groups according to whether they presented with a full stomach:empty stomach group(group E)and full stomach group(group F).The patients′fasting time,coexisting diseases and types of operation were recorded.Multivariate logistic regression analysis was performed on the indicators with statistically significant differences between groups to identify the risk factors for preoperative full stomach in the patients undergoing emergency surgery.Results One hundred and seventy-nine cases were finally included,with 121 cases in group E and 58 cases in group F.Compared with group E,the fasting time was<6 h,and the incidence of coexisting diabetes was increased in group F(P<0.05).Coexisting diabetes mellitus was an independent risk factor for preoperative full stomach in the patients undergoing emergency surgery(P<0.05),and OR(95%confidence interval)was 11.968(2.392-59.870).Conclusion Coexisting diabetes mellitus is an independent risk factor for preoperative full stomach in the patients undergoing emergency surgery.