床旁超声测量胃窦、胃底横截面积变化对非肥胖女性全麻诱导期间胃充气敏感性的比较

摘要

Objective To compare the changes of antrum and fundus cross‐sectional area ( CSA ) measured by bedside ultrasonography on gastric insufflation during anesthesia induction in non‐obese female patients and analyze the relationships between these changes as well as postoperative nausea and vomiting ( PONV ) . Methods Fourty‐six patients scheduled for elective gynecological laparoscopic operations were enrolled in the study . T he patients w ho appeared the comet‐tail artifacts were defined as gastric insufflation positive group( GI+ group) ,w hile the ones without comet‐tail artifacts were defined as gastric insufflation negative group( GI‐ group) . Blood oxygen saturation ( SPO 2 ) ,end‐expiratory partial pressure of CO 2 ( PET CO2 ) ,tidal volume( T V ) were recorded after 180 seconds ventilation in both groups . T he longitudinal and anteroposterior diameters of gastric antrum and fundus were measured before and after facemask ventilation respectively and the corresponding CSA were calculated . T he cutoff values of prediction of gastric insufflation were determined according to the ROC curve and the corresponding sensitivity and specificity were calculated . PONV of the two groups were also recorded . Results T he analysis was based on the remaining 41 data sets actually . T here were 13 patients in GI‐group and 28 ones in GI+ group . Compared with GI‐group ,the changes of T V and fundus CSA in GI+ group had significantly differences( P ＜0 .05) ; w hile compared with before mask ventilation ,the changes of antrum and fundus CSA in both groups had significantly differences ( P ＜0 .05).T he areas of antrum and fundus CSA under the ROC curve (95% CI) were 0 .67 and 0 .80 ,with cut‐off value 3 .19 cm2 and 24 .90 cm2 ,sensitivity 0 .93 and 0 .93 and specificity 0 .39 and 0 .69 ,respectively .T he incidence of PONV in GI+ group was higher than that in GI‐group( P ＜0 .05). Conclusions Changes of fundus CSA by ultrasonography might be superior to antrum CSA in gastric insufflation caused by 20 cm H2 O peak airway pressure of facemask ventilation during anesthesia induction . Gastric insufflation caused by positive pressure ventilation is related with PONV for young female patients undergoing gynecological laparoscopic operation .%目的 比较全麻诱导期非肥胖女性超声下胃窦、胃底横截面积(CSA )的变化,分析二者与胃充气以及术后恶心呕吐(PONV )的关系.方法 择期行妇科腹腔镜手术患者46例,根据面罩正压通气过程中胃窦部"彗星尾征"的有无将患者分为阳性组和阴性组,记录两组通气180 s后血氧饱和度(SPO2 )、呼气末CO2 分压(PETCO2 )、潮气量(TV) ,测量通气前后胃窦、胃底的上下径、前后径并计算各自的CSA ;根据ROC曲线预测胃充气的胃窦、胃底CSA ,并计算其敏感性及特异性;记录两组PONV的发生率.结果 实际入组患者41例,阴性组13例,阳性组28例.两组通气后 T V 、胃底CSA的差异均有统计学意义( P ＜ 0 .05 ) ;阳性组通气前后胃窦、胃底CSA 的差异均有统计学意义(P＜0 .05) ;胃窦、胃底 CSA 的 ROC 曲线下面积(95% CI )分别为 0 .67 、 0 .80 ,阈值分别为 3 .19 cm2 、 24 .90 cm2 ,敏感性分别为 0 .93 、 0 .93 ,特异性分别为 0 .39 、 0 .69 ;两组术后 PONV的发生率差异有统计学意义( P ＜0 .05 ) .结论 全麻诱导期20 cm H2 O 压力值面罩正压通气时,超声测量胃底CSA比胃窦CSA的变化更能反映由此引起的胃充气状态;正压通气导致的胃充气与年轻女性患者手术后恶心呕吐的发生有关.