Division of Anesthesia, Asahikawa Redcross Hospital, 1-1-1-1 Akebono, Asahikawa, Hokkaido, 070-8530, Japan.
J Anesth. 2012 Aug;26(4):574-8. doi: 10.1007/s00540-012-1353-2. Epub 2012 Feb 21.
There has been no report on risk factors for gastric distension (GD) when inducing general anesthesia in an emergency situation. The aim of this study was to clarify the risk factors for GD in patients with acute appendicitis at their hospital visit.
We reviewed medical records of patients from April 2007 to March 2010 who underwent open appendectomy for acute appendicitis and were diagnosed pathologically. GD was defined as a larger anteroposterior diameter and larger lateral diameter of the stomach than those of the left kidney in computed tomography (CT) imaging. The primary outcome was the presence of GD. Candidate variables such as patient characteristics, physical findings, and CT imaging findings associated with GD were assessed. Time after beginning of abdominal pain was categorized and compared. Determinants with significant univariate association (P < 0.20) with the primary outcome were used to construct multivariable logistic regression models.
We enrolled 121 patients and divided this cohort into a GD group (44 cases, 36%) and a non-GD group (77 cases, 64%). Results of univariate analysis showed longer duration of time after beginning of abdominal pain (P = 0.016), younger age (P < 0.001), and more frequent distended small bowel (P < 0.001) in the GD group than in the non-GD group. In multivariate analysis, age [odds ratio (OR) = 0.939, P = 0.002] and time after beginning of abdominal pain (OR = 1.807, P = 0.031) were shown to be independent risk factors.
Younger appendicitis patients with acute abdominal pain for 1 or more days should be treated as patients with high risk for GD.
在紧急情况下诱导全身麻醉时，尚未有关于胃扩张（GD）风险因素的报告。本研究旨在阐明该院就诊的急性阑尾炎患者发生 GD 的风险因素。
我们回顾了 2007 年 4 月至 2010 年 3 月期间接受开腹阑尾切除术治疗并经病理诊断为急性阑尾炎的患者的病历。GD 定义为 CT 成像中胃的前后直径和左右直径大于左肾的相应直径。主要结局为 GD 的发生。评估与 GD 相关的患者特征、体格检查和 CT 成像表现等候选变量。腹痛开始后时间分为几个时间段并进行比较。具有与主要结局显著单变量关联（P<0.20）的确定因素用于构建多变量逻辑回归模型。
我们共纳入了 121 例患者，将该队列分为 GD 组（44 例，36%）和非 GD 组（77 例，64%）。单变量分析结果显示，GD 组腹痛开始后时间较长（P=0.016）、年龄较小（P<0.001）和小肠扩张更频繁（P<0.001）。多变量分析显示，年龄（比值比 [OR] = 0.939，P=0.002）和腹痛开始后时间（OR=1.807，P=0.031）是独立的风险因素。
对于腹痛 1 天或以上的年轻急性阑尾炎患者，应将其视为 GD 高危患者。
