糖尿病患者骨折内固定手术围麻醉期误吸风险的超声评估

Ultrasound assessment of the risk of aspiration during perianaesthesia of internal fracture fixation in diabetic patients

目的探讨超声在评估合并糖尿病骨折内固定手术患者胃排空中的应用,指导降低患者胃内容物反流误吸风险。方法选取本院2019年2月至2020年6月期间骨折内固定手术合并糖尿病患者64例为观察组,并选择无糖尿病骨折内固定手术患者40例作为对照组,利用超声监测两组患者胃窦截面积、胃收缩频率及胃内容物等变化,评估比较反流误吸风险。结果两组餐后即刻胃窦截面积比较无明显差异(t=1.019,P>0.05);观察组餐后即刻胃收缩频率明显低于对照组(t=5.312,P<0.05)。T1时刻两组胃排空率比较无明显差异(t=1.130,P>0.05),T2、T3、T4等时刻观察组胃排空率均低于对照组(t=6.320、9.714、11.216,P均<0.05);且观察组误吸风险评分明显高于对照组(Z=2.937,P<0.05)。结论糖尿病手术患者围麻醉期误吸风险高于非糖尿病患者,利用超声评估手术患者胃动力可以预判误吸风险。

Objective To explore the application of ultrasound in evaluating gastric emptying in diabetic patients with internal fracture fixation,and to guide the reduction of the risk of gastric contents reflux and aspiration.Methods Sixty-four diabetic patients with internal fracture fixation in our hospital from February 2019 to June 2020 were selected as the observation group,and 40 non-diabetic patients with internal fracture fixation were selected as the control group.The changes of gastric antrum cross-sectional area,gastric contraction frequency,and gastric contents in the two groups were monitored by ultrasound.The risk of reflux aspiration was evaluated and compared.Results There was no significant difference in the cross-sectional area of gastric antrum between the two groups immediately after the meal(t=1.019,P>0.05).The frequency of gastric contraction immediately after the meal in the observation group was significantly lower than that in the control group(t=5.312,P<0.05).There was no significant difference in gastric emptying rate between the two groups at T1(t=1.130,P>0.05).The gastric emptying rate of the observation group at T2,T3,and T4 was lower than that of the control group(t=6.320,9.714,11.216,P<0.05).The aspiration risk score of the observation group was significantly higher than that of the control group(Z=2.937,P<0.05).Conclusion The risk of aspiration in diabetic patients during perianaesthesia is higher than that in non-diabetic patients.The use of ultrasound to assess gastric motility in surgical patients can predict the risk of aspiration.