【作者】 王娜；

【导师】 曹俊；

【作者基本信息】 重庆医科大学 ， 临床医学（专业学位）， 2021， 硕士

【摘要】 目的:通过床旁超声评估产妇饱胃程度,预测返流误吸风险。方法:收集2020年5月至2021年1月于重庆医科大学附属第一医院住院产妇,孕龄≥36周,18岁≤年龄≤45岁,ASA≤Ⅲ级,BMI≤35kg/cm~2。不同时点采用床旁超声测定其右侧卧位时胃窦长径、短径、横截面积。将右侧卧位横截面积>10.30cm~2定义为超声下饱胃者。将禁食时间<6h定为依据禁食时间判断的饱胃者。同时记录其年龄、身高、体重、孕周、禁食时间、合并妊娠期糖尿病、最后一餐进食食物重量。结果:本研究共纳入169名产妇。禁食时间<6h的产妇46人,其中超声下饱胃者18人(39.13%)。禁食时间≥6h的产妇123人,其中超声下饱胃者1人(0.81%)。禁食时间判断产妇是否饱胃与超声判断产妇是否饱胃两种方法的kappa系数为0.469,p<0.001。超声下空胃产妇右侧卧位短径、长径、短径×长径95%分位数95%置信区间(CI)分别为2.84cm(95%CI,2.60～3.19cm)、4.41cm(95%CI,4.26～4.64cm)、11.68cm~2(95%CI,10.12～12.77cm~2)。超声下空胃产妇CSARLD与孕周、年龄、身高、体重、BMI无统计学意义。产妇饱胃程度与最后一餐进食重量有统计学意义,与合并妊娠期糖尿病无统计学意义。结论:依据目前ASA禁食指南评估产妇饱胃程度并不可靠。通过超声测量胃窦横截面积来判断产妇饱胃程度更为合理。超声测量胃窦短径×长径更为简单,其值大于12.77cm~2可按照饱胃处理。食物重量可影响胃排空,产妇合并妊娠期糖尿病不影响产妇胃排空。床旁超声实时判断产妇饱胃程度有较高临床应用价值,可用于预测返流误吸风险及指导胃管安置。更多还原

【Abstract】 Objective: The bedside ultrasound was used to assess the gastric fullness and predict the risk of reflux and aspiration.Methods: Pregnant women were recruited in the First Affiliated Hospital of Chongqing Medical University from May 2020 to January 2021,gestational age ≥ 36 weeks,18 years ≤ age ≤ 45 years,ASA ≤grade Ⅲ,and BMI ≤ 35 kg/cm~2.An ultrasound assessment of the long diameter,short diameter,and cross-sectional area of the gastric antrum in the right decubitus position was performed at different time.The cross-sectional area of the right side decubitus> 10.30cm~2 is defined as a full stomach under ultrasound.The fasting time <6h is regarded as the full stomach by fasting guidelines of the American Society of Anesthesiologists in 2017.Age,height,weight,and gestational age were conducted.Results: 169 women were enrolled.There were 18(39.13%)parturients defined as full stomach by ultrasound in the 46 parturients whose fasting time was less than 6h.There was 1(0.81%)parturient defined as full stomach by ultrasond in the 123 parturients whose fasting time were more than 6h.The kappa coefficient of the two methods of diagnosis of a full stomach was 0.469,p<0.001.95% pregnant cohort with empty stomach by ultrasond for antral short diameter,long diameter,and short diameter × long diameter were 2.84cm(95%CI,2.60～3.19cm),4.41cm(95%CI,4.26～4.64cm)and 11.68cm~2(95%CI,10.12～12.77cm~2)in the right lateral decubitus position.No correlation was seen between the CSARLD of women with empty stomach under ultrasound and the item such as age,gestational age,height,weight,and BMI.The degree of maternal satiety was statistically significant with the food weight at the last meal,but not statistically significant with gestational diabetes.Conclusions: The current ASA fasting guidelines to assess the gastric fullness is not reliable.It is more reasonable to judge the degree of gastric fullness by measuring the cross-sectional area of gastric antrum by ultrasound.Ultrasound measurement of the short diameter × long diameter of the gastric antrum is simpler,and the value greater than12.77cm~2 can be treated as a full stomach.Food weight can affect gastric emptying,and maternal gestational diabetes does not affect gastric emptying.Bedside ultrasound has a high clinical application value in real-time judgment of the fullness of the women’s stomach,and can be used to predict the risk of reflux and aspiration and guide the placement of the gastric tube.更多还原