Department of Anesthesia, University of Toronto, ON, Canada.
Anesth Analg. 2011 Jul;113(1):93-7. doi: 10.1213/ANE.0b013e31821b98c0. Epub 2011 May 19.
Aspiration pneumonia remains a serious anesthetic-related complication. A reliable diagnostic tool to assess gastric volume is currently lacking. We recently demonstrated that gastric sonography can provide reliable qualitative and quantitative information about gastric content and volume in healthy volunteers. In the current study, we performed a prospective qualitative and quantitative analysis of the gastric antrum in 200 fasted patients undergoing elective surgery.
A standardized gastric scanning protocol was applied before anesthetic induction. Patients were classified following a 3-point grading system based solely on qualitative sonographic assessment of the antrum in the supine and right lateral decubitus positions.
Eighty-six patients were classified as grade 0 (empty antrum); 107 patients as grade 1 (minimal fluid volume detected only in the right lateral decubitus position); and 7 patients were classified as grade 2 (antrum clearly distended with fluid visible in both supine and lateral positions). The 3-point grading system correlated with total gastric fluid volume as predicted by a previously reported mathematical model. Essentially grade 0 corresponds to a completely empty stomach, grade 1 corresponds to negligible fluid volumes (16 ± 36 mL) within normal ranges expected for fasted patients, and grade 2 correlates with significantly higher predicted gastric fluid volumes (180 ± 83 mL) beyond previously reported "safe" limits. One patient with a grade 2 antrum had an episode of significant regurgitation of gastric contents on emergence from anesthesia.
We propose a 3-point grading system based exclusively on qualitative sonographic assessment of the gastric antrum that correlates well with predicted gastric volume. This grading system could be a promising "biomarker" to assess perioperative aspiration risk. Before it can be applied widely to clinical practice, this diagnostic tool needs to be further validated and characterized.
吸入性肺炎仍然是一种严重的与麻醉相关的并发症。目前缺乏一种可靠的诊断工具来评估胃容量。我们最近证明，胃超声检查可以为健康志愿者的胃内容物和容量提供可靠的定性和定量信息。在目前的研究中，我们对 200 例接受择期手术的禁食患者的胃窦进行了前瞻性定性和定量分析。
在诱导麻醉前应用标准化的胃扫描方案。根据胃窦在仰卧位和右侧卧位的超声检查的定性评估，仅基于 3 点分级系统对患者进行分类。
86 例患者被分类为空胃窦（grade 0）；107 例患者被分类为胃窦少量液体（仅在右侧卧位检测到）（grade 1）；7 例患者被分类为胃窦明显扩张（仰卧位和侧卧位均可见液体）（grade 2）。3 点分级系统与以前报道的数学模型预测的总胃液体量相关。基本上，grade 0 对应于完全空胃，grade 1 对应于禁食患者预期的正常范围内的可忽略不计的液体量（16±36ml），grade 2 对应于明显更高的预测胃液体量（180±83ml）超过以前报道的“安全”范围。1 例胃窦 grade 2 的患者在麻醉苏醒时出现胃内容物明显反流。
我们提出了一种仅基于胃窦的超声定性评估的 3 点分级系统，与预测胃容量密切相关。这种分级系统可能是评估围手术期吸入风险的有前途的“生物标志物”。在广泛应用于临床实践之前，需要进一步验证和描述这种诊断工具。
Zotero 插件