Department of Surgery, Changi General Hospital, Singapore 529889, Singapore.
World J Gastroenterol. 2012 Sep 7;18(33):4585-92. doi: 10.3748/wjg.v18.i33.4585.
To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction.
Subjects were patients who presented with a diagnosis of possible intestinal obstruction based on symptoms, signs, and radiological findings. A 3M™ 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, sound-to-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.
A total of 71 patients were studied during the period July 2009 to January 2011. Forty patients had 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 pseudo-obstruction. 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.
Auscultation of bowel sounds is non-specific for diagnosing bowel obstruction. Differences in sound characteristics between large bowel and small bowel obstruction may help determine the likely site of obstruction.
利用电子听诊器分析肠鸣音，以支持肠梗阻的临床诊断。
本研究对象为根据症状、体征和影像学检查结果疑似肠梗阻的患者。使用 3M 公司 Littmann（®）Model 4100 电子听诊器。让患者仰卧，从每位患者的下腹部采集 6 个持续 8 秒的肠鸣音录音。对录音的声音持续时间、音与音之间的间隔、主要频率和峰值频率进行分析。回顾临床和放射学数据，并将患者分为急性、亚急性或无肠梗阻。比较这些亚组患者的肠鸣音特征。在存在梗阻的情况下，确定梗阻部位，并测量肠腔直径以与肠鸣音相关联。
2009 年 7 月至 2011 年 1 月期间共研究了 71 名患者。40 名患者患有急性肠梗阻（27 例小肠梗阻，13 例大肠梗阻），11 名患者患有亚急性肠梗阻（8 例小肠梗阻，3 例大肠梗阻），20 名患者无肠梗阻（诊断为其他疾病）。25 名患者在同一住院期间因急性腹部疾病接受了手术干预（占 35.2%）。共进行了 426 次录音，其中 420 次用于分析。急性肠梗阻、亚急性肠梗阻和无肠梗阻患者之间的音与音之间的间隔、主要频率和峰值频率没有显著差异。在急性大肠梗阻中，声音持续时间明显较长（中位数 0.81 秒与 0.55 秒，P = 0.021），主要频率明显较高（中位数 440 Hz 与 288 Hz，P = 0.003）与急性小肠梗阻相比。急性大肠梗阻与大肠假性梗阻之间无明显差异。对于小肠梗阻患者，随后接受手术治疗的患者与未接受手术治疗的患者之间的音与音之间的间隔明显更长（中位数 1.29 秒与 0.63 秒，P < 0.001）。在急性小肠梗阻和急性大肠梗阻中，肠腔直径与肠鸣音特征之间均无相关性。
肠鸣音听诊对诊断肠梗阻无特异性。大肠和小肠梗阻之间的声音特征差异可能有助于确定梗阻的可能部位。
