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.

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.

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.

Diagnostic value of digital continuous bowel sounds in critically ill patients with acute gastrointestinal injury: A prospective observational study

BACKGROUND Acute gastrointestinal injury(AGI)is common in intensive care unit(ICU)and worsens the prognosis of critically ill patients.The four-point grading system proposed by the European Society of Intensive Care Medicine is subjective and lacks specificity.Therefore,a more objective method is required to evaluate and determine the grade of gastrointestinal dysfunction in this patient population.Digital continuous monitoring of bowel sounds and some biomarkers can change in gastrointestinal injuries.We aimed to develop a model of AGI using continuous monitoring of bowel sounds and biomarkers.AIM To develop a model to discriminate AGI by monitoring bowel sounds and biomarker indicators.METHODS We conducted a prospective observational study with 75 patients in an ICU of a tertiary-care hospital to create a diagnostic model for AGI.We recorded their bowel sounds,assessed AGI grading,collected clinical data,and measured biomarkers.We evaluated the model using misjudgment probability and leave-one-out cross-validation.RESULTS Mean bowel sound rate and citrulline level are independent risk factors for AGI.Gastrin was identified as a risk factor for the severity of AGI.Other factors that correlated with AGI include mean bowel sound rate,amplitude,interval time,Sequential Organ Failure Assessment score,Acute Physiology and Chronic Health Evaluation II score,platelet count,total protein level,blood gas potential of hydrogen(pH),and bicarbonate(HCO3-)level.Two discriminant models were constructed with a misclassification probability of<0.1.Leave-one-out cross-validation correctly classified 69.8%of the cases.CONCLUSION Our AGI diagnostic model represents a potentially effective approach for clinical AGI grading and holds promise as an objective diagnostic standard for AGI.

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.

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。

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。

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。

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。

穿戴式多导肠鸣音记录仪的设计和实现

该文实现了穿戴式多导肠鸣音记录仪,可以长时间连续采集并存储5个通道的肠鸣音信号。文中还实测人体肠鸣音信号,验证了该记录仪的可用性。

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。

肠鸣音信号的自适应滤波及其特征提取方法研究

目的:肠鸣音的去噪和特征提取。方法:文中首先采用自适应干扰对消去除肠鸣音中混叠的环境噪声,然后运用小波分析、归一化香农能量分布、功率谱密度估计等多种方法,从多个角度对肠鸣音进行分析处理,这些方法都致力于肠鸣音的特征提取和识别分类。结果:通过定性和定量分析,几种不同类型的肠鸣的特征值存在典型差异。结论:肠鸣音的检测和分析在胃肠道疾病的诊断治疗中具有重要的价值,利用上述方法能有效区分不同类型的肠鸣音,有助于肠道疾病的辅助诊断。

基于小波的肠鸣音滤波方法及其应用

目的:肠鸣音是肠生理状态的反映,在临床急腹症的诊断中具有重要的意义。为深入研究肠鸣音的产生机理,需要对采集的肠鸣音进行滤波,并开发相关系统,以期为临床医生的疾病诊断提供便捷。方法:在肠鸣音采集系统的基础上,采用小波的方法进行肠鸣音的滤波,消除影响医生进行疾病诊断的干扰噪声,并搭建了相应的肠鸣音滤波分析系统。结果:搭建的分析系统与前端的采集系统一起,可以有效的组成肠鸣音记录与处理系统。结论:经过临床医生的鉴别,所采用的滤波方式能有效滤出干扰噪声,所搭建的系统具备的信号转换及音频播放功能,可以为临床医生进行疾病诊断提供便捷的方式。

对比分析不同护理方法对腹部手术后胃肠功能恢复的影响

目的探讨不同护理方法对患者腹部手术后胃肠功能恢复的影响。方法选取92例我院普外科收治的腹部手术患者,对照组患者给予常规护理,研究组在对照组的基础上,采用背部穴位按摩与早期活动结合的护理方法,观察两组患者胃肠功能恢复情况。结果研究组的肠鸣音恢复时间、肛门排气时间以及首次排便时间均短于对照组患者,差异具有统计学意义(P<0.05)。结论患者术后应用背部穴位按摩结合早期活动的护理方法,有助于患者胃肠功能的恢复。

肠鸣音在胃肠外科临床应用中价值的再认识

肠鸣音听诊是腹部体格检查中的一项重要内容,其在腹部外科及胃肠疾病诊治中的价值曾被广为认可并写入经典的医学专著。然而,由于肠鸣音具有个体差异大、随机性强等特点,在实际临床工作中,许多医生几乎不关注这一临床体征,有些医生甚至完全抛弃了听诊器。而且,对于肠鸣音听诊的临床意义,目前尚缺乏高级别的循证医学研究数据的支持,使得肠鸣音听诊的临床价值成为了学术界争论的焦点。基于此,文章拟从肠鸣音的临床意义和肠鸣音发生的病理生理学机制进行系统的文献回顾,对肠鸣音研究面临的挑战加以展望并进行深入探讨,以期进一步完善和推动肠鸣音在胃肠外科中的临床应用。

护理观察指标对上消化道出血患者出血是否停止的判断与分析

目的通过护理观察指标判断上消化道出血患者出血是否停止。方法对136例呕血停止后患者的生命征(脉搏和收缩压)、临床表现(头晕或眩晕、口渴、肠鸣音亢进及血尿素氮)、血象(血红蛋白浓度、红细胞计数、血细胞比容、网织红细胞计数)等指标进行5 d连续观察并记录,并以大便隐血试验和胃镜检查判断有无出血。结果呕血停止第3天各项出血观察指标绝大多数患者均存在。第5天出血的其他征象恢复正常,肠鸣音持续>10 bpm,网织红细胞计数持续增高,提示仍在出血。结论上消化道出血患者,在出血的其他征象恢复正常后,肠鸣音持续>10 bpm,网织红细胞计数持续增高,是判断出血是否停止的重要指标。