Gastric ultrasound-assisted diagnosis of undifferentiated shock:A case report

Rationale:Peptic ulcer disease and variceal bleeding are two of the most common causes of gastrointestinal(GI)bleeding.GI bleeding can present with symptoms of hemodynamic instability such as tachycardia and shock.Patient’s Concern:A 33-year-old man with confusion and hypotension(blood pressure:70/40 mmHg and pulse rate:140/min)was brought by emergency medical services from home to the emergency department without any companion.The patient was in undifferentiated shock.His hypotension was assessed with inferior vena cava(IVC)size and collapsibility,and rapid ultrasound in shock and hypotension(RUSH)protocol was used to investigate the cause of his shock.Following the RUSH protocol when scanning the IVC,parts of the stomach were seen in its vicinity and suspended heterogeneous particles were observed in the fluid.After seeing these particles,we suspected GI bleeding.Diagnosis:Endoscopy confirmed GI bleeding.Interventions:After placing an orogastric tube and suction,about 2 L of coffee-ground fluid with clots was removed.We started intravenous proton-pump inhibitors 80 mg bolus,followed by a continuous infusion of 8 mg/h.The patient received about 2 L of normal saline and 2 units of packed red blood cells to correct his hypotension.Outcomes:After being admitted to the GI ward and treated for three days,the patient was discharged from the hospital with a hemoglobin level of 11 g/dL and continued to have an outpatient follow-up at the clinic.Lessons:The use of gastric ultrasound in conjunction with the RUSH protocol can help to diagnose undifferentiated hypotensive shock.The components of the RUSH exam are the heart(H),IVC(I),Morrison’s/FAST abdominal views with the aorta(MA),and pulmonary and pipes scanning(P),and can be memorized with the mnemonic:HI-MAP.We would like to introduce a new mnemonic:Hi-MAPS,adding stomach(S)to the RUSH protocol in undifferentiated hypotension and shock to evaluate upper GI bleeding.

Gastric emptying evaluation by ultrasound prior colonoscopy:An easy tool following bowel preparation

AIM: To investigate the gastric emptying after bowel preparation to allow general anaesthesia. METHODS: A prospective, non-comparative, and nonrandomized trial was performed and registered on Eudra CT database(2011-002953-80) and on www.trial.gov(NCT01398098). All patients had a validated indication for colonoscopy and a preparation using sodium phosphate(NaP) tablets. The day of the procedure, patients took 4 tablets with 250 mL of water every 15 min, three times. The gastric volume wasestimated every 15 min from computed antral surfaces and weight according to the formula of Perlas et al(Anesthesiology, 2009). Colonoscopy was performed within the 6 h following the last intake.RESULTS: Thirty patients were prospectively included in the study from November 2011 to May 2012. The maximum volume of the antrum was 212 mL, achieved 15 min after the last intake. 24%, 67% and 92% of subjects had an antral volume below 20 mL at 60, 120 and 150 min, respectively. 81% of patients had a Boston score equal to 2 or 3 in each colonic segment. No adverse events leading to treatment discontinuation were reported.CONCLUSION: Gastric volume evaluation appeared to be a simple and reliable method for the assessment of gastric emptying. Data allow considering the NaP tablets bowel preparation in the morning of the procedure and confirming that gastric emptying is achieved after two hours, allowing general anaesthesia.

Modified B-ultrasound method for measurement of antral section only to assess gastric function and guide enteral nutrition in critically ill patients

AIM To establish a modified B-ultrasound method of measuring the antral section only to assess gastric motility in healthy people,and evaluate its application in guiding enteral nutrition(EN) in critically ill patients. METHODS First,30 healthy volunteers were selected. The modified B-ultrasound method and the traditional B-ultrasound method were applied to assess gastric function. The correlation of indices of gastric function between the two groups was analyzed statistically. In addition,64 critically ill patients were selected,and the modified B-ultrasound method and the gastric juice withdrawal method were applied to guide the implementation of EN. Daily caloric value,the time required to achieve complete EN,ICU stay,hospitalization time,and serum prealbumin and albumin levels were recorded and compared between the two groups. Kaplan-Meier survival curve was used to compare the complications of EN between the two groups. RESULTS In healthy subjects,there was a good correlation among gastric emptying time,antral contraction frequency andantral motility index between the two groups(r = 0.57,0.61 and 0.54,respectively). The study on critically ill patients also revealed that a better effect of EN was achieved in the modified B-ultrasound method group,in which patients had shorter ICU stay and hospitalization time and higher levels of serum prealbumin and albumin. The Kaplan-Meier survival analysis revealed that the improved B-ultrasound method was associated with significantly fewer EN complications(P = 0.031).CONCLUSION The modified B-ultrasound method can provide a good real-time assessment of gastric function and has a better effect than the traditional method in guiding EN in critically ill patients.

How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review

AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) for staging of gastric cancers. METHODS: Only EUS studies confirmed by surgery were selected. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Articles were searched in Medline, Pubmed, Ovid journals, Cumulative index for nursing & allied health literature, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane control trial registry. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. 2 × 2 tables were constructed with the data extracted from each study. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specifi city, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fi xed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights. RESULTS: Initial search identified 1620 reference articles and of these, 376 relevant articles were selected and reviewed. Twenty-two studies (n = 1896) which met the inclusion criteria were included in this analysis. Pooled sensitivity of T1 was 88.1% (95% CI: 84.5-91.1) and T2 was 82.3% (95% CI: 78.2-86.0). For T3, pooled sensitivity was 89.7% (95% CI: 87.1-92.0). T4 hada pooled sensitivity of 99.2% (95% CI: 97.1-99.9). For nodal staging, the pooled sensitivity for N1 was 58.2% (95% CI: 53.5-62.8) and N2 was 64.9% (95% CI: 60.8-68.8). Pooled sensitivity to diagnose distant metastasis was 73.2% (95% CI: 63.2-81.7). The P for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION: EUS results are more accurate with advanced disease than early disease. If EUS diagnoses advanced disease, such as T4 disease, the patient is 500 times more likely to have true anatomic stage of T4 disease.

Interventional endoscopic ultrasound for a symptomatic pseudocyst secondary to gastric heterotopic pancreas

Heterotopic pancreas(HP) is a relatively uncommon entity that is defined as pancreatic tissue without a true anatomical or vascular connection to the pancreas. HP does not cause symptoms in most cases but can occasionally produce various manifestations, including nausea, vomiting, abdominal pain, and even heterotopic pancreatitis. Here, we report an unusual case in which heterotopic pancreatitis complicated by the formation of a pseudocyst that caused gastric outlet obstruction was diagnosed based on serum hyperamylasemia and findings from endoscopic ultrasonography(EUS)-guided fine needle aspiration(EUS-FNA) cytology. EUS-guided single pigtail stent insertion was successfully performed for recurrent gastric outlet obstruction. The patient has remained healthy and symptom-free during 4 years of surveillance. In the context of the relevant literature, the described case is a rare case of HP complicated by a pseudocyst treated via EUS-FNA and stent insertion.

Low intensity ultrasound-induced apoptosis in human gastric carcinoma cells

AIM: To investigate the low intensity ultrasound (US)-induced apoptosis in human gastric carcinoma cells and its potential mechanism and to suggest a new therapeutic approach to gastric carcinoma. METHODS: Human SGC-7901 gastric carcinoma cells were cultured in vitro and irradiated by low intensity US for 10 min at different intensities with different incubation times after irradiation. Morphologic changes were examined under microscope with trypan blue staining and then the percentage of early apoptotic cells was detected by flow cytometry (FCM) with double staining of fluorescein isothiocyanate (FITC)-Annexin V/propidium iodide (PI). Two-dimensional electrophoresis (2DE) was used to get the protein profile and some proteins differently expressed after US irradiation were identifi ed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Functional analysis was performed to investigate the mechanism of US-induced cell apoptosis. RESULTS: The percentage of apoptotic cells increased about 10% after US irradiation (12.0 W/cm^2, 12 h culture). The percentage of early apoptosis and secondary necrosis in the US-irradiated cells increased with the increased US intensity. Moreover, apoptotic cells increased with the increased culture time after US irradiation and reached its maximum at about 12 h.Several new proteins appeared after US irradiation and were up or down regulated more than 2 times. Some heat shock proteins (HSPs) were found to be associated with the signal process simulating the apoptosis of cells. CONCLUSION: Low intensity US could induce apoptosis in human gastric carcinoma cells. US-induced apoptosis is related to US intensity/culture time. US-induced apoptosis may be caspases-dependent and endoplasmic reticulum (ER) stress-triggered apoptosis may also contribute to it. Proteomic experimental system is useful in finding the protein alteration in carcinoma cells after US irradiation, helping to develop a new cancer therapy.

High intensity focused ultrasound in combination with chemotherapy by the regime of PFC: a clinical study for advanced gastric carcinoma

Objective： To evaluate the recent curative efficacy and security of High intensity focused ultrasound （HIFU） in combination with chemotherapy（PFC） in patients with advanced gastric carcinoma. Method： Sixty patients with measurable advanced gastric carcinoma, proved pathologically, were divided into Group A and Group B. Group A： Patients were treated by HIFU（FEP-BY01） in combination with chemotherapy（PFC, paclitaxel, cisplatin and 5-fluorouracil）. Group B： Patients were treated with the single regime of PFC. Results： All cases could be evaluated, ha group A, 5 patients achieved complete response, 17 patients achieved partial response,and a response rate was 73.3%. The stable disease（SD） and the inefficiency all were 13.3% （4/30） respectively, and msurvival time（MST） was 13.9 months. In group B, 2 patients achieved complete response, 14 patients achieved partial response, and a response rate was 53.3%. The stable disease（SD） was 23.3%（7/30）. The inefficiency all were 23.3%（7/30） respectively, and median survival time was 9.6 months. There was significant difference between two groups MST（ P 〈 0.05）. Major toxicities included bone marrow depression, nausea, vomiting and alopecia, without significant differences between two groups（ P 〉 0.05）. Conclusion： This study shows that HIFU in combination with chemotherapy（PFC） was a new efficent and secure therapy for the patients with advanced gastric carcinoma. It was observed that the MST was prolonged. Prospective trials should be warranted to determine the result.

Endoscopic ultrasound-guided cutting of holes and deep biopsy for diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors using a novel vertical diathermic loop

AIM To report on a more accurate diagnostic possibility offered by endoscopic ultrasound-guided cutting of holes and deep biopsy(EUS-CHDB) for pathologic diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors.METHODS Ten consecutive patients who were suspected of having gastric invasive tumors or gastrointestinal submucosal tumors underwent EUS-CHDB with a novel vertical diathermic loop. We reviewed their medical data and analysed the effectiveness and safety of this new method. The final diagnosis was based on the surgical pathology or clinical/imaging follow-up. RESULTS EUS-CHDB was performed successfully in all the ten patients. Neither severe haemorrhage nor perforation occurred in any patient. Among the ten patients, there were three cases of gastric linitis plastica, one case of gastric lymphoma, five cases of gastrointestinal stromal tumors(GISTs), and only one case of chronic non-atrophic gastritis. That is, nine(90%) of the cases treated by EUS-CHDB showed positive findings.CONCLUSION EUS-CHDB may be a technically feasible and safe option for patients with gastric infiltrative tumors or gastrointestinal submucosal tumors. EUS-CHDB may be used as a remedial or even preferred biopsy method for submucosal lesions.

The Value of Multiple Imaging Methods in Primary Gastric Lymphoma

Primary gastric lymphoma (PGL) is the most common type of extranodal lymphoma that originates from the lymphatic tissue within the gastric submucosa. In the past two decades, the treatment of PGL has been overturned from surgery to non-surgical individualized treatment, and its treatment and prognosis are different from those of other malignant lesions in the stomach, so early diagnosis, accurate staging, and timely monitoring of outcome are extremely important. Unlike intra-nodal lymphoma, PGL can be evaluated by endoscopy, endoscopic ultrasound and gastric ultrasound, in addition to conventional imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT), which are specific to the gastrointestinal tract. This article introduces the application of various imaging modalities in the management of primary gastric lymphoma. .

超声内镜结合LCI/BLI-ME判断根除幽门螺杆菌后早期胃癌浸润深度的研究

目的 探讨超声内镜结合联动成像技术/蓝激光成像技术-放大内镜(LCI/BLI-ME)对根除幽门螺杆菌后早期胃癌浸润深度的判断及其准确性的影响因素,评价其临床应用价值。方法 收集2017年10月至2023年6月武汉市第一医院收治的91例根除幽门螺杆菌后早期胃癌患者的临床资料,以病理学检查结果作为判断标准,总结根除幽门螺杆菌后胃黏膜及早期胃癌在内镜下的特征表现,分析超声内镜结合LCI/BLI-ME对根除幽门螺杆菌后早期胃癌浸润深度的判断准确性及影响其判断准确性的相关因素。诊断效能的统计学描述采用灵敏度、特异度、准确度表示;采用χ^(2)检验和多因素Logistic回归分析对超声内镜的诊断结果与术后病理学检查结果进行比较。结果 超声内镜结合LCI/BLI-ME对根除幽门螺杆菌后早期胃癌浸润深度判断的总体准确率77.08%,对uT1a期及uT1b期的判断准确率分别为82.86%和61.53%。分期不足12例,占17.14%;分期过度10例,占38.46%。对黏膜层病变判断的诊断敏感度85.29%,诊断特异度57.14%,阳性预测值82.86%,阴性预测值61.5%。单因素和多因素Logistic回归分析结果表明,病变最大径、组织分化类型是影响判断准确性的因素,而病变部位、病灶形态与判断准确性无相关性。病灶越大,对浸润深度判断的准确性越低;组织分化程度越低,对浸润深度判断的准确性越低。结论 超声内镜结合LCI/BLI-ME对根除幽门螺杆菌后早期胃癌uT1a期的浸润深度判断具有较好的临床应用价值,病灶大小及组织分化程度对判断的准确性有影响。

早期帕金森病患者胃排空障碍在胃肠超声造影中的表现

目的研究早期帕金森病患者的非运动症状—胃排空障碍在胃肠超声造影中的表现。方法对32例门诊及住院的、诊断为早期帕金森病(HY分级Ⅰ~Ⅱ期)并存在胃排空障碍(包括恶心呕吐、早饱、餐后持续性上腹胀满等症状)的患者(PD组)和同期30例健康体检者(对照组)进行胃肠超声造影检查,记录并测量两组入组者在饮入胃肠造影剂后的不同时间点(0~120 min)的胃窦收缩幅度(ACA)、胃窦收缩频率(ACF)、胃动力指数(GMI)、胃排空率(GER)、胃排空时间(GET)、胃壁增厚率、胃蠕动波速度等胃动力参数。结果PD组患者在各时间点的ACA、ACF、GMI及GER值均低于对照组(P<0.01,P<0.05);胃窦排空时间大于对照组(P均<0.01);30 min时PD组胃壁增厚率及胃蠕动波速度均低于对照组(均P<0.01)。结论早期帕金森病患者的胃排空障碍可借助胃肠超声造影得到有效评估。

Management of gastric variceal bleeding:Role of endoscopy and endoscopic ultrasound

Gastric varices(GVs)are notorious to bleed massively and often difficult to manage with conventional techniques.This mini-review addresses endoscopic management principles for gastric variceal bleeding,including limitations of ligation and sclerotherapy and merits of endoscopic variceal obliteration.The article also discusses how emerging use of endoscopic ultrasound provides optimism of better diagnosis,improved classification,innovative management strategies and confirmatory tool for eradication of GVs.

超声引导下腹横肌平面阻滞中罗哌卡因在腹腔镜胃癌根治术后镇痛中的应用效果

目的探讨超声引导下腹横肌平面阻滞中罗哌卡因在腹腔镜胃癌根治术后镇痛的应用效果。方法选取2019年11月至2022年3月钦州市第一人民医院收治的60例接受腹腔镜胃癌根治术患者作为研究对象,按随机数字表法将其分为观察组(30例)与对照组(30例),观察组患者采用超声引导下腹横肌平面阻滞联合罗哌卡因镇痛,对照组采用肌注曲马多镇痛。比较两组患者术后恢复情况、视觉模拟评分法(VAS)评分、Ramsay镇静评分、匹兹堡睡眠质量指数量表(PSQI)评分及不良反应等。结果观察组术后首次排气时间、首次进食时间、首次下床活动及总住院天数均短于对照组,术后VAS评分、不良反应总发生率低于对照组,术后PSQI评分均低于对照组,总住院费用少于对照组,差异有统计学意义(P<0.05)。结论在腹腔镜胃癌根治术后,采用超声引导下腹横肌平面阻滞联合罗哌卡因进行镇痛可使患者术后疼痛轻微,不良反应较少,康复速度较快,住院费用较低,预后较好,具有较高的应用价值。

麻醉苏醒期间不同吸入氧浓度对腹腔镜胃癌根治术患者术后肺不张的影响

目的探讨麻醉苏醒期间不同吸入氧浓度对腹腔镜胃癌根治术患者术后肺不张的影响。方法选择行择期腹腔镜下胃癌根治术的老年患者68例,随机分为两组:高吸入氧浓度组(C组)和低吸入氧浓度组(L组),每组34例。在麻醉苏醒期间,L组采用40%吸入氧浓度,C组采用100%吸入氧浓度。采用床旁肺超声评估患者12个区域(左肺和右肺各6个区域)的肺超声评分(LUS)。记录入室时(T_(0))、术后30min(T_(4))的LUS评分及术后肺不张的发生率。记录入室(T_(0))、气腹结束时(T_(1))、拔管时(T_(2))、出PACU时(T_(3))的心率(HR)、平均动脉压(MAP),血气分析记录血氧分压(PaO_(2)),计算氧合指数(OI)。记录拔管后在PACU中SpO_(2)<94%事件的发生率。于术前1d(D_(0))和术后1d(D_(1))、3d(D_(2))、5d(D_(3))测定第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、1秒率(FEV_(1)/FVC)。记录术后1d临床肺部感染评分(CPIS)和术后7d肺部并发症的发生情况。结果L组和C组从气腹结束至拔管时间分别为(36.4±5.2)min和(37.3±4.2)min(P>0.05)。与C组相比,L组在T4时的肺超声评分及肺不张发生率明显降低(P<0.05)。L组在T_(3)时,PaO_(2)、OI均明显升高(P<0.05)。在PACU中L组Sp0_(2)<94%事件的发生率低于C组(P<0.05)。与D_(0)时比较,D_(1-3)两组患者的FEV_(1)、FVC、FEV_(1)/FVC均明显降低(P<0.05),与C组比较,L组在D_(1)时FEV_(1)、FVC、FEV_(1)/FVC均明显升高(P<0.05)。术后1dCPIS评分和术后7d肺部并发症发生率两组无明显差异(P>0.05)。结论麻醉苏醒期间低吸入氧浓度能降低老年患者腹腔镜胃癌根治术术后肺不张的发生率及严重程度,改善术后早期肺功能。

分析不同危险度胃间质瘤超声内镜特征及免疫组化结果的相关性

目的探讨不同危险度胃间质瘤超声内镜特征及免疫组化结果的相关性,为临床诊断和治疗提供参考。方法回顾性收集2018年1月至2023年7月就诊于兰州大学第二医院并行手术治疗的胃间质瘤患者相关指标,分析不同危险度之间的差异性。结果胃间质瘤的平均发病年龄为(56.02±10.94)岁,首发症状为黑便对于胃间质瘤的不同分级有意义,不同危险度的患者所接受的治疗方式也有显著差异(P<0.05)。极低危、低危、中危、高危四组的部位、起源层次、边界、回声、有无囊性变、钙化或血流信号对危险度的分级无差异(P>0.05);肿瘤大小、生长方式、形状、内部回声均匀度、外观对于胃间质瘤术后危险分级评估有意义(P<0.05),多因素Logistic回归显示肿瘤大小是独立影响因素(P<0.05)。免疫组化结果示DOG-1、CD34、SMA、Desmin是否阳性对胃间质瘤术后危险度的分级无影响(P>0.05);而Vimentin的阳性表达、Ki-67指数及核分裂象与危险度显著相关(P<0.05)。结论胃间质瘤的不同侵袭度分级与病灶大小、形状、回声等有关系,超声内镜能较好地诊断胃间质瘤,结合免疫组化相关指标能更好地评估胃间质瘤患者的整体情况,为临床诊疗提供参考。

胃窦超声、AGIUS评分联合注射器回抽法指导老年重症病人肠内营养的疗效研究

目的:探究胃窦超声、胃肠损伤超声(AGIUS)检查评分联合注射器回抽法指导老年重症病人肠内营养(EN)的疗效。方法:随机选取于2022年7月1日至2023年7月1日入住大连市友谊医院重症医学科的老年病人为样本,随机分为实验组及对照组各30例病人,实验组通过每日两次床旁胃窦超声、AGIUS检查评分及每日两次注射器回抽法来指导EN喂养,对照组通过日四次注射器回抽法来指导EN喂养。比较两组鼻饲开始时间和鼻饲7、10、14日达到目标热量情况,鼻饲期间EN并发症发生情况、营养指标改善情况、淋巴细胞总数的差异,比较两组住院天数及28d死亡率的差异。结果:实验组开始鼻饲时间(1.47±0.82)d早于对照组(2.00±0.64)d,具有统计学差异(P<0.05)。实验组EN时的腹泻、腹胀及中断营养发生例数低于对照组(P<0.05),具有统计学差异,但两组误吸例数无明显差异(P>0.05)。鼻饲7、10、14达到目标热量例数实验组均高于对照组,具有统计学差异(P<0.05)。实验组病人在实验10日后检测前白蛋白、白蛋白及转铁蛋白含量均高于对照组,具有统计学差异(均P<0.05)。但两组淋巴细胞总数、住院天数及28d死亡率无统计学差异(P>0.05)。结论:胃窦超声、AGIUS检查评分联合注射器回抽法可使EN开始时间提前,更快达到目标热量,并减少EN并发症发生。

床旁胃窦超声评估门诊无痛消化内镜诊疗患者胃内容物的应用价值研究

目的研究床旁胃窦超声用于评估门诊无痛消化内镜诊疗患者胃内容物及反流误吸风险的应用价值。方法选择2021年11月至2022年3月在桂林医学院第二附属医院择期行无痛消化内镜诊疗患者616例,在无痛消化内镜检查前10 min行床旁胃窦超声检查。观察并记录胃内容物性质、Perlas胃窦分级、右侧卧位胃窦横截面积(RLD CSA)、预测胃容积等超声检查结果及麻醉方案改变情况,记录胃镜实际胃容积及胃镜发现饱胃情况。通过Pearson相关分析评估RLD CSA、预测胃容积与实际胃容积的相关性,通过受试者工作特征(ROC)曲线分析评估RLD CSA对饱胃的预测价值。结果19例患者未获得典型胃窦超声图像,最终597例患者纳入统计分析。所有患者超声检查时间为(2.9±0.9)min;超声诊断饱胃患者42例(7.0%)。超声诊断饱胃患者均改变麻醉方案,其中4例患者延期,38例患者行普通胃镜检查。胃镜下发现实际饱胃患者31例,其中液体28例,固体3例。所有患者未发生反流误吸。Pearson相关分析显示,RLD CSA、预测胃容积与实际胃容积呈正相关(P<0.05)。ROC曲线分析结果显示,RLD CSA具有预测饱胃的应用价值[AUC(95%CI)=0.926(0.864~0.987),P<0.001],最佳截断值为7.87 cm^(2),对应的灵敏度和特异度分别为96.4%、78.6%。结论床旁胃窦超声可用于评估门诊无痛消化内镜诊疗患者胃内容物及反流误吸风险,可行性强、准确性高,具有良好的临床应用价值。

外科急诊手术患者风险胃发生的相关因素研究

目的通过超声测量胃窦部截面积(CSA)计算出胃内容物体积(GV),探索拟行急诊外科手术患者风险胃发生的相关因素。方法前瞻性选择2022年3月至2023年3月嘉兴市第一医院外科急诊就诊后拟行急诊手术患者190例,采用超声检查监测胃窦部图像,计算CSA、胃容积以及单位体重胃容量(GV/W),筛选风险胃患者;同时记录患者年龄、性别、BMI、禁食时间(FT)、发病-进食间隔时长(IT)、有无糖尿病、腹部手术史、发病部位、末次进食量、末次进食性质、末次进食肉类及发病后有无进食等因素,并分析各因素与风险胃发生的相关性。结果190例外科急诊患者中,检出风险胃患者51例(26.8%);风险胃患者中有糖尿病、IT>0 h(发病后有进食)及末次进食量≥400 mL的占比均高于非风险胃患者(均P<0.05);Pearson相关分析提示外科急诊患者GV/W与FT之间无相关性(r=-0.124,P>0.05)。结论胃窦超声检查能为判断外科急诊患者胃排空情况提供更加客观的依据,急诊手术患者术前不能单纯依靠FT评估是否饱胃,腹部疾病、糖尿病、末次进食量≥400 mL及发病后进食患者拟行急诊外科手术时风险胃发生率提高。

超声引导下TAPB联合罗哌卡因在腹腔镜胃癌根治术后镇痛中的应用研究进展

术后疼痛管理是围手术期麻醉管理的重要内容。腹横肌平面阻滞(TAPB)是一种新型麻醉阻滞方式,其能够有效阻断腹壁前侧感觉神经,具有较好的镇痛效果,已广泛应用于临床。目前,关于腹腔镜胃癌根治术后疼痛控制的研究仍不多,相关的总结和指导较少见,该文对超声引导下TAPB的现状、解剖学基础、入路方式、常用药物和阻滞方法等研究进行了综述,旨在为临床治疗提供循证依据。

ICU患者肠内营养过程中应用超声监测胃残余量的Meta分析

目的:评价超声监测胃残余量的效果在ICU重症患者肠内营养中的应用价值,为重症患者肠内营养科学实施提供证据。方法:系统检索中国期刊全文数据库(CNKI)、中文科技期刊数据库(VIP)、万方数据知识服务平台、中国生物医学文献数据库(CBM)、PubMed、Embase、WebofScience和Cochrane图书馆从建库至2021年9月15日发表的有关超声监测胃残余量指导ICU重症患者肠内营养治疗的文献。文献检索、文献筛选、资料提取及质量评价由2名研究员分别完成,使用RevMan5.4软件进行Meta分析。结果:纳入24篇文献,共2357例患者。与传统注射器回抽法相比,超声监测胃残余量可以降低反流/呕吐发生率(RR=0.43,95%CI=0.34~0.55)、误吸发生率(RR=0.51,95%CI=0.34~0.75)、腹泻发生率(RR=0.61,95%CI=0.49~0.75)、腹胀发生率(RR=0.56,95%CI=0.42~0.74)、ICU呼吸机相关性肺炎(VAP)发生率(RR=0.49,95%CI=0.35~0.68),缩短患者ICU住院时间(MD=-1.71,95%CI=-2.92~-0.50)、提高白蛋白水平(MD=2.45,95%CI=1.35~3.54),合并效应量有统计学意义(P<0.05)。结论:ICU重症患者实施肠内营养过程中利用超声监测胃残余量,可能减少发生各种肠内营养并发症,改善重症患者的营养状况。