Diagnostic Accuracy of Computerized Bowel Sound Analysis with Non-Invasive Devices for Irritable Bowel Syndrome:A Systematic Review and Meta-Analysis

Objective To assess the diagnostic accuracy of bowel sound analysis for irritable bowel syndrome(IBS)with a systematic review and meta-analysis.Methods We searched MEDLINE,Embase,the Cochrane Library,Web of Science,and IEEE Xplore databases until September 2023.Cross-sectional and case-control studies on diagnostic accuracy of bowel sound analysis for IBS were identified.We estimated the pooled sensitivity,specificity,positive likelihood ratio,negative likeli-hood ratio,and diagnostic odds ratio with a 95% confidence interval(CI),and plotted a summary receiver operat-ing characteristic curve and evaluated the area under the curve.Results Four studies were included.The pooled diagnostic sensitivity,specificity,positive likelihood ratio,nega-tive likelihood ratio,and diagnostic odds ratio were 0.94(95%CI,0.87‒0.97),0.89(95%CI,0.81‒0.94),8.43(95%CI,4.81‒14.78),0.07(95%CI,0.03‒0.15),and 118.86(95%CI,44.18‒319.75),respectively,with an area under the curve of 0.97(95%CI,0.95‒0.98).Conclusions Computerized bowel sound analysis is a promising tool for IBS.However,limited high-quality data make the results'validity and applicability questionable.There is a need for more diagnostic test accuracy studies and better wearable devices for monitoring and analysis of IBS.

Predicting prolonged postoperative ileus in gastric cancer patients based on bowel sounds using intelligent auscultation and machine learning

BACKGROUND Prolonged postoperative ileus(PPOI)delays the postoperative recovery of gastrointestinal function in patients with gastric cancer(GC),leading to longer hospitalization and higher healthcare expenditure.However,effective monitoring of gastrointestinal recovery in patients with GC remains challenging because of AIM To explore the risk factors for delayed postoperative bowel function recovery and evaluate bowel sound indicators collected via an intelligent auscultation system to guide clinical practice.METHODS This study included data from 120 patients diagnosed with GC who had undergone surgical treatment and postoperative bowel sound monitoring in the Department of General Surgery II at Shaanxi Provincial People's Hospital between January 2019 and January 2021.Among them,PPOI was reported in 33 cases.The patients were randomly divided into the training and validation cohorts.Significant variables from the training cohort were identified using univariate and multivariable analyses and were included in the model.RESULTS The analysis identified six potential variables associated with PPOI among the included participants.The incidence rate of PPOI was 27.5%.Age≥70 years,cTNM stage(Ⅰ and Ⅳ),preoperative hypoproteinemia,recovery time of bowel sounds(RTBS),number of bowel sounds(NBS),and frequency of bowel sounds(FBS)were independent risk factors for PPOI.The Bayesian model demonstrated good performance with internal validation:Training cohort[area under the curve(AUC)=0.880,accuracy=0.823,Brier score=0.139]and validation cohort(AUC=0.747,accuracy=0.690,Brier score=0.215).The model showed a good fit and calibration in the decision curve analysis,indicating a significant net benefit.CONCLUSION PPOI is a common complication following gastrectomy in patients with GC and is associated with age,cTNM stage,preoperative hypoproteinemia,and specific bowel sound-related indices(RTBS,NBS,and FBS).To facilitate early intervention and improve patient outcomes,clinicians should consider these factors,optimize preoperative nutritional status,and implement routine postoperative bowel sound monitoring.This study introduces an accessible machine learning model for predicting PPOI in patients with GC.

Spectral analysis of bowel sounds in intestinal obstruction using an electronic stethoscope

AIM: To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction. METHODS: Subjects were patients who presented with a diagnosis of possible intestinal obstruction based on symptoms, signs, and radiological findings. A 3MTH Littmann Model 4100 electronic stethoscope was used in this study. With the patients lying supine, six 8-second recordings of bowel sounds were taken from each patient from the lower abdomen. The recordings were analysed for sound duration, soundto-sound interval, dominant frequency, and peak frequency. Clinical and radiological data were reviewed and the patients were classified as having either acute, subacute, or no bowel obstruction. Comparison of bowel sound characteristics was made between these subgroups of patients. In the presence of an obstruction, the site of obstruction was identified and bowel calibre was also measured to correlate with bowel sounds. RESULTS: A total of 71 patients were studied during the period July 2009 to January 2011. Forty patientshad acute bowel obstruction (27 small bowel obstruction and 13 large bowel obstruction), 11 had subacute bowel obstruction (eight in the small bowel and three in large bowel) and 20 had no bowel obstruction (diagnoses of other conditions were made). Twenty-five patients received surgical intervention (35.2%) during the same admission for acute abdominal conditions. A total of 426 recordings were made and 420 recordings were used for analysis. There was no significant difference in sound-to-sound interval, dominant frequency, and peak frequency among patients with acute bowel obstruction, subacute bowel obstruction, and no bowel obstruction. In acute large bowel obstruction, the sound duration was significantly longer (median 0.81 s vs 0.55 s, P = 0.021) and the dominant frequency was significantly higher (median 440 Hz vs 288 Hz, P = 0.003) when compared to acute small bowel obstruction. No significant difference was seen between acute large bowel obstruction and large bowel pseudoobstruction. For patients with small bowel obstruction, the sound-to-sound interval was significantly longer in those who subsequently underwent surgery compared with those treated non-operatively (median 1.29 s vs 0.63 s, P < 0.001). There was no correlation between bowel calibre and bowel sound characteristics in both acute small bowel obstruction and acute large bowel obstruction. CONCLUSION: Auscultation of bowel sounds is nonspecific for diagnosing bowel obstruction. Differences in sound characteristics between large bowel and small bowel obstruction may help determine the likely site of obstruction.

多导睡眠监测设备和肠鸣音设备之间数据同步采集方法研究

目的提出一种基于敲击脉冲信号的两个独立设备数据同步采集的方法,以实现数据的同步采集。方法利用多导睡眠监测设备的鼾声传感器与肠鸣音设备相互敲击产生瞬态脉冲信号作为同步标记信号,基于同步标记信号的三阶累积量实现同步标记信号的识别和对齐,并采用多组同步标记信号评价数据同步的精度。结果多导睡眠监测设备的鼾声传感器和肠鸣音设备相互敲击,产生了清晰明确的同步标记脉冲信号,结合时域特征和三阶累积量实现了同步标记信号的精确识别和对齐。经过多组同步标记信号识别验证表明,此种同步方法可保证同步精度范围在5 ms内。结论该数据同步采集方法简单易行,可保证多导睡眠监测设备和肠鸣音设备的高精度同步采集,同时也为其他完全独立的多个设备数据同步采集提供参考。

经鼻肠梗阻导管置入术治疗妊娠期肠梗阻的效果分析

目的探讨经鼻肠梗阻导管置入术治疗妊娠期肠梗阻的效果。方法通过随机数字表法将2021年1月至2022年1月本院接收的92例妊娠期肠梗阻患者分为观察组(46例,采用经鼻肠梗阻导管置入术治疗)和对照组(46例,采用普通鼻胃管进行胃肠减压)。观察2组患者疗效、胃肠功能以及免疫功能情况,并记录母婴结局。结果观察组患者总有效率高于对照组(P<0.05)。2组患者治疗后的CD_(4)^(+)T淋巴细胞水平上升,IgG、IgA、IgM、CD_(8)^(+)T淋巴细胞水平降低,且观察组均优于对照组,差异有统计学意义(P<0.05)。观察组患者治疗后肠鸣音恢复时间、肛门排气时间、首次排便时间均早于对照组(P<0.05)。观察组中有42例(91.30%)患者经保守治疗后足月分娩,母婴结局良好,对照组中有35例(76.09%)经保守治疗后康复出院,2组患者康复出院率比较差异具有统计学意义(P<0.05)。结论经鼻肠梗阻导管置入术能有效改善妊娠期肠梗阻患者胃肠功能,提高免疫功能及康复率。

基于残差神经网络、双向长短期记忆网络和注意力机制的肠鸣音检测方法研究

肠鸣音可以反映胃肠道的运动和健康状况,然而,传统的人工听诊方式存在主观性偏差且耗时耗力。为了更好地辅助医生对肠鸣音的诊断,提高肠鸣音检测的可靠性和高效性,该研究提出了一种结合残差神经网络(ResNet)、双向长短期记忆网络(BiLSTM)和注意力机制的深度神经网络模型。首先使用自主研发的多通道肠鸣音采集系统采集了大量带标签的临床数据,采用多尺度小波分解和重构方法对肠鸣音信号进行预处理,然后提取对数梅尔谱图特征送入网络进行训练,最后通过10折交叉验证和消融实验来评估模型的性能和验证其有效性。实验结果表明,该模型在精确率、召回率和F1分数方面分别达到了83%、76%和79%,能够有效地检测出肠鸣音片段并定位其起止时间,表现优于以往的算法。该算法不仅可以为医生在临床实践中提供辅助信息,还为肠鸣音的进一步分析和研究提供了技术支撑。

运脾散联合小儿推拿治疗小儿便秘食积型60例临床观察

目的:探讨运脾散联合小儿推拿治疗小儿便秘食积型的效果。方法:选择便秘食积型患儿120例作为研究对象。依据随机数字表格的方法完成分组,对照组(n=60),观察组(n=60)。对照组在常规方法基础上联合使用推拿方法。观察组在对照组基础上再联合使用中药运脾散。对比两组治疗前后的中医主症积分、肠鸣音频率。对比两组治疗后1个月内的复发情况。对比两组治疗效果。对比两组治疗过程中的不良反应情况。结果:两组在术前的中医主症积分、肠鸣音频率数据差异无统计学意义(P>0.05)。治疗后,两组的中医主症积分均降低,肠鸣音频率均增高(P<0.05)。治疗后,观察组的中医主症积分低于对照组,肠鸣音频率高于对照组(P<0.05)。观察组患儿在治疗后1个月内的复发率低于对照组(P<0.05)。观察组治疗有效率为96.67%,高于对照组治疗有效率(86.67%)(P<0.05)。两组治疗过程中的不良反应发生率的数据差异无统计学意义(P>0.05)。结论:运脾散联合小儿推拿治疗小儿便秘食积型,可以改善患儿的症状,提升肠鸣音频率,降低复发率,提升治疗效果,具有良好的安全性。

Accuracy of abdominal auscultation for bowel obstruction

AIM:To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction.METHODS:Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann&#174; Electronic Stethoscope. The recordings were processed to yield 25-s sound sequences in random order on PCs. Observers,recruited from doctors within the department,classified the sound sequences as either normal or pathological. The reference tests for bowel obstruction were intraoperative and endoscopic findings and clinical follow up. Sensitivity and specificity were calculated for each observer and compared between junior and senior doctors. Interobserver variation was measured using the Kappa statistic.RESULTS:Bowel sound sequences from 98 patients were assessed by 53(33 junior and 20 senior) doctors. Laparotomy was performed in 47 patients,35 of whom had bowel obstruction. Two patients underwent colorectal stenting due to large bowel obstruction. The median sensitivity and specificity was 0.42(range:0.19-0.64) and 0.78(range:0.35-0.98),respectively. T h e re wa s n o s i g n i f i c a n t d i ffe re n c e i n a cc u ra c y between junior and senior doctors. The median frequency with which doctors classified bowel sounds as abnormal did not differ significantly between patients with and without bowel obstruction(26% vs 23%,P = 0.08). The 53 doctors made up 1378 unique pairs and the median Kappa value was 0.29(range:-0.15-0.66).CONCLUSION:Accuracy and inter-observer agreement was generally low. Clinical decisions in patients with possible bowel obstruction should not be based on auscultatory assessment of bowel sounds.

电针对腹腔镜胆囊切除术后胃肠功能恢复的影响

目的观察术后即刻电针干预对腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后胃肠功能恢复的影响。方法将84例行腹腔镜胆囊切除术患者随机分为试验组和对照组,每组42例。对照组采用常规围术期管控;试验组在对照组基础上,于术后即刻进行电针干预。观察两组术后首次肛门自主排气时间及肠鸣音恢复情况(肠鸣音首次出现时间、肠鸣音恢复正常时间和肠鸣音出现到恢复时间),比较两组临床疗效。结果试验组术后首次肛门自主排气时间及肠鸣音首次出现时间和恢复正常时间均明显少于对照组,两组比较差异均具有统计学意义(P<0.05)。试验组总有效率和愈显率分别为100.0%和95.2%,对照组分别为97.6%和76.2%。试验组愈显率明显高于对照组,差异具有统计学意义(P<0.05)。结论术后即刻电针干预可明显缩短腹腔镜胆囊切除术后患者首次肛门自主排气时间及肠鸣音首次出现时间和恢复正常时间,从而有效促进术后胃肠功能的恢复。

综合护理干预在子宫肌瘤手术患者中的应用效果

目的 探讨综合护理干预在子宫肌瘤手术患者中的应用效果。方法 选取2019年4月至2021年5月在本院实施手术治疗的110例子宫肌瘤患者,依据入院编号的奇偶性将其分为对照组与观察组,各55例。对照组实施常规护理干预,观察组实施综合护理干预。比较两组的干预效果。结果 观察组的肠鸣音恢复时间、排气恢复时间、下床活动时间、排便恢复时间、饮食恢复时间及离院时间短于对照组(P<0.05)。术后1周,观察组的抑郁自评量表(SDS)及焦虑自评量表(SAS)评分低于对照组,行为自尊、社会自尊及外表自尊评分高于对照组(P<0.05)。术后3 d,观察组的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)水平低于对照组(P<0.05)。结论 综合护理干预用于子宫肌瘤手术患者中,可促进康复,改善心理状态,提高自尊水平。

艾灸联合穴位按摩护理对妇科腹部术后胃肠功能恢复的影响

目的 探讨艾灸联合穴位按摩护理对妇科腹部术后胃肠功能恢复的影响。方法 将符合标准的85例乐安县中医院妇科就诊并行腹部手术患者随机数字表法分成对照组(43例)和观察组(42例),其中对照组术后给予常规补液、抗感染治疗及护理,观察组在上述基础上给予艾灸联合穴位按摩护理,比较2组护理效果。结果 观察组肠鸣音恢复时间、首次肛门排气时间和首次排便时间均短于对照组(P<0.05),术后第2天和第3天胃肠动力恢复情况评分均高于对照组(P<0.05),腹胀发生率低于对照组(P<0.05),舒适度分值高于对照组(P<0.05)。结论 艾灸联合穴位按摩护理可促进妇科腹部术后患者胃肠功能快速恢复。

大承气汤联合奥曲肽在术后粘连性肠梗阻治疗中的效果

目的分析大承气汤联合奥曲肽在术后粘连性肠梗阻治疗中的效果。方法选取2021年11月—2022年12月于漳浦天福医院行腹部手术,但手术后发生不同程度的粘连性肠梗阻的患者56例,依据随机数字表法分为两组,每组各28例。观察组运用大承气汤联合常规西医疗法,对照组运用常规胃肠减压、纠正酸碱平衡及药物治疗的常规西医疗法。分别记录两组患者治疗后1、3、5 d的胃肠减压量;记录两组患者的首次排气时间、恢复肠鸣音时间、排水样便时间、胃液呈清时间;并对比分析两组患者的治疗总有效率情况。结果两组患者治疗后1、3、5 d的胃肠减压量间比较,差异无统计学意义(P>0.05)。观察组首次排气时间、恢复肠鸣音时间、排水样便时间、胃液呈清时间短于较对照组,差异有统计学意义(P<0.05)。于治疗后7 d记录两组患者治疗有效情况,其中观察组有效21例、显效6例,无效1例;对照组有效17例、显效4例,无效7例;观察组治疗有效率(96.43%)明显高于对照组(71.43%),差异有统计学意义(P<0.05)。结论大承气汤联合常规西医疗法相较于常规单纯西医疗法在术后粘连性肠梗阻的治疗效果更为显著,患者恢复更快、痛苦更少,因此值得临床作为粘连性肠梗阻治疗的新思路。

快速康复外科护理在剖宫产产妇中的应用效果

目的:观察快速康复外科护理在剖宫产产妇中的应用效果。方法:选取2021年10月至2022年1月该院收治的100例剖宫产产妇进行前瞻性研究,按照随机数字表法分为观察组与对照组各50例。对照组给予常规护理,观察组给予快速康复外科护理,比较两组首次下床活动时间、肠鸣音恢复时间、首次肛门排气时间、产后泌乳时间、负性情绪[汉密尔顿焦虑量表(HAMA)与汉密尔顿抑郁量表(HAMD)]评分、并发症发生率和护理满意度。结果:观察组首次下床活动时间、肠鸣音恢复时间、首次肛门排气时间和产后泌乳时间均短于对照组,差异有统计学意义(P<0.05);护理后,两组HAMA、HAMD评分均低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组护理满意度为96.00%,明显高于对照组的80.00%,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:快速康复外科护理应用于剖宫产产妇可缩短首次下床活动时间、肠鸣音恢复时间、首次肛门排气时间和产后泌乳时间,降低负性情绪评分,以及提高护理满意度,效果优于常规护理。

不同治疗方案对小儿乳糖吸收不良引起的肠痉挛的改善效果研究

目的:观察厚朴温中汤联合常规西医治疗肠痉挛患儿的效果。方法:选取2019年1月至2021年1月该院收治的92例肠痉挛患儿进行前瞻性研究,按照随机数字表法分为观察组与对照组各46例。对照组采用常规西医治疗,观察组在对照组基础上采用厚朴温中汤治疗,比较两组治疗总有效率、胃肠功能指标恢复时间(肠鸣音恢复时间、肛门排气时间和自主排便时间)、住院时间、复发率和不良反应发生率。结果:观察组治疗总有效率为97.83%,明显高于对照组的82.61%,差异有统计学意义(P<0.05);观察组肠鸣音恢复时间、肛门排气时间、自主排便时间和住院时间均短于对照组,差异有统计学意义(P<0.05);观察组出院后6个月复发率为4.35%,明显低于对照组的17.39%,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:厚朴温中汤联合常规西医治疗肠痉挛患儿可提高治疗总有效率,缩短胃肠功能指标恢复时间和住院时间,以及降低复发率,效果优于单纯常规西医治疗。

静脉注射利多卡因对腹腔镜胃减容术患者的镇痛效果及对术后胃肠功能的影响

目的 探讨静脉注射利多卡因对腹腔镜胃减容术患者的镇痛效果及对术后胃肠功能的影响。方法 选择2021年10月—2022年10月本院收治的92例拟行腹腔镜胃减容术治疗的患者作为研究对象,随机数表法分为常规组(给予常规镇痛)和研究组(给予小剂量静脉利多卡因+常规镇痛)两组,每组各46例。对比两组患者手术时间、住院时间;对比两组患者胃肠功能恢复情况;对比两组患者住院期间药物不良反应发生情况。结果 研究组术后12 h、术后24 h时刻VAS评分均低于常规组(P<0.05),研究组住院时间、复苏时间短于常规组(P<0.05)。研究组术后首次排气时间、肠鸣音恢复时间、首次排便时间均短于常规组(P<0.05)。两组患者住院期间药物不良反应总发生率比较,差异无统计学意义(P>0.05);两组患者未出现出血现象,术后恢复较好。结论 静脉利多卡因对腹腔镜胃减容术患者的镇痛效果显著,可改善术后首次排气时间、肠鸣音恢复时间、首次排便时间,且安全可靠。

电针足三里穴对肠鸣音影响的初步观察

目的观察针刺足三里穴对肠鸣音的影响。方法应用自行研制的计算机肠鸣音采集记录系统,检测23名健康成人志愿者在电针足三里穴前后肠鸣音的变化。结果针刺对肠鸣音的影响是双向的,可使肠鸣音发生明显变化。与电针前比,电针对肠鸣音的影响经统计学处理,具有非常显著差异(P<0.01)。结论针刺足三里穴对人体肠鸣音可产生显著的影响,提示针刺足阳明胃经局部穴位对胃肠运动具有一定的影响作用。

基于C8051F340单片机的肠鸣音采集系统的设计

介绍了一种8通道肠鸣音采集系统。它以C8051F340单片机为核心设计外围电路,利用其内部USB控制器进行数据传输,实现了肠鸣音的实时采集、显示与存储。该系统具有精度高、性能稳定等特点,为肠鸣音的检测提供了一种新的手段。

大承气汤联合麦粒灸治疗术后胃肠动力障碍的临床研究

目的:探讨大承气汤联合麦粒灸治疗术后胃肠动力障碍的临床疗效研究。方法:选取2015年1月—2018年1月在医院治疗的98例晚期胃癌患者,随机分为观察组和对照组,每组各49例。观察组采用大承气汤联合麦粒灸治疗,对照组采用麦粒灸治疗。观察并记录肠鸣音恢复、肛门排气及排便时间。结果:对照组患者肠鸣音恢复、肛门排气及排便时间各方面均不及观察组,具统计学意义(P<0.05)。观察组患者术后总有效率(91.84%)明显高于对照组(77.55%),差异显著,有统计学意义(P<0.05)。结论:大承气汤联合麦粒灸治疗术后胃肠动力障碍,可提升患者临床疗效,改善患者胃肠动力,缩短患者康复时间,患者认可度高,值得推广以及应用。

腹腔镜与开腹胃十二指肠溃疡穿孔修补术的临床疗效比较研究

目的通过对比分析腹腔镜胃十二指肠溃疡穿孔修补术（1aparoscopic neoplasty for perforated gastroduodenal ulcer,LNPGU）与传统开腹胃十二指肠溃疡穿孔修补术（open neoplasty for perforated gastroduodenal ulcer,ONPGU）的疗效,旨在为临床合理选择治疗方案提供科学依据。方法选取2014年1月～2015年1月间行腹腔镜胃十二指肠溃疡穿孔修补术治疗的胃十二指肠溃疡穿孔患者32例,同时选择2012年12月～2013年12月行传统开腹胃十二指肠溃疡穿孔修补术患者32例作为对照。观察并对比两组的手术时间、术中出血量、术后肠鸣音恢复情况、住院时间及并发症发生率。结果 LNPGU组的术中出血量显著少于ONPGU组,LNPGU组的肠鸣音恢复时间、住院时间显著短于ONPGU组,差异有统计学意义（P〈0.05）;LNPGU组并发症发生率显著低于ONPGU组,差异有统计学意义（P〈0.05）。结论腹腔镜胃十二指肠溃疡穿孔修补术的临床疗效在促进胃肠功能恢复、并发症方面显著优于传统开腹胃十二指肠溃疡穿孔修补术,值得推广和应用。

基于语音端点检测的全腹部肠鸣音信号识别

肠鸣音是人体重要的生理信号之一,不同的肠鸣音能够反映不同的胃肠状态。该文通过自主设计的可穿戴全腹部肠鸣音记录仪,获取长时程肠鸣音数据,在自适应噪声对消、小波阈值去噪处理之后,采用基于短时能量的语音端点检测方法,可识别有效肠鸣音。实验过程和结果表明,肠鸣音记录仪操作简单、可靠,通过处理、分析和端点检测提取算法,对于有效肠鸣音的识别准确率高,具有一定的临床实用性和研究意义。