计算机断层扫描评估严重创伤患者胃容量：院前气道管理对胃内气体的影响。
Computer tomographic assessment of gastric volume in major trauma patients: impact of pre-hospital airway management on gastric air.
机构信息
Departement of Anaesthesiology and Intensive Care Medicine AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Dr.-Franz-Rehrl-Platz 5, 5010, Salzburg, Austria.
Department of Anesthesiology and Critical Care Medicine, Medical University, Innsbruck, Austria.
出版信息
Scand J Trauma Resusc Emerg Med. 2020 Jul 28;28(1):72. doi: 10.1186/s13049-020-00769-y.
BACKGROUND
Gastric dilation is frequently observed in trauma patients. However, little is known about average gastric volumes comprising food, fluids and air. Although literature suggests a relevant risk of gastric insufflation when endotracheal intubation (ETI) is required in the pre-hospital setting, this assumption is still unproven.
METHODS
Primary whole body computed tomographic (CT) studies of 315 major trauma patients admitted to our Level 1 Trauma Centre Salzburg during a 7-year period were retrospectively assessed. Gastric volumes were calculated employing a CT volume rendering software. Patients intubated in the pre-hospital setting by emergency physicians (PHI, N = 245) were compared with spontaneously breathing patients requiring ETI immediately after arrival in the emergency room (ERI, N = 70).
RESULTS
The median (range) total gastric content and air volume was 402 (26-2401) and 94 (0-1902) mL in PHI vs. 466 (59-1915) and 120 (1-997) mL in ERI patients (p = .59 and p = .35). PHI patients were more severely injured when compared with the ERI group (injury severity score (ISS) 33 (9-75) vs. 25 (9-75); p = .004). Mortality was higher in the PHI vs. ERI group (26.8% vs. 8.6%, p = .001). When PHI and ERI patients were matched for sex, age, body mass index and ISS (N = 50 per group), total gastric content and air volume was 496 (59-1915) and 119 (0-997) mL in the PHI vs. 429 (36-1726) and 121 (4-1191) mL in the ERI group (p = .85 and p = .98). Radiologic findings indicative for aspiration were observed in 8.1% of PHI vs. 4.3% of ERI patients (p = .31). Gastric air volume in patients who showed signs of aspiration was 194 (0-1355) mL vs. 98 (1-1902) mL in those without pulmonary CT findings (p = .08).
CONCLUSION
In major trauma patients, overall stomach volume deriving from food, fluids and air must be expected to be around 400-500 mL. Gastric dilation caused by air is common but not typically associated with pre-hospital airway management. The amount of air in the stomach seems to be associated with the risk of aspiration. Further studies, specifically addressing patients after difficult airway management situations are warranted.
背景
创伤患者常出现胃扩张。然而，人们对包含食物、液体和空气的胃内平均容量知之甚少。尽管文献表明在院前环境中需要进行气管插管（ETI）时存在胃充气的相关风险，但这一假设仍未得到证实。
方法
对在 7 年内入住萨尔茨堡 1 级创伤中心的 315 例严重创伤患者的原发性全身计算机断层扫描（CT）研究进行回顾性评估。使用 CT 容积渲染软件计算胃容量。在院前环境中由急诊医师进行插管的患者（PHI，N=245）与直接在急诊室到达后需要 ETI 的自主呼吸患者（ERI，N=70）进行比较。
结果
PHI 组的总胃内容物和空气量中位数（范围）分别为 402（26-2401）和 94（0-1902）mL，ERI 组分别为 466（59-1915）和 120（1-997）mL（p=0.59 和 p=0.35）。与 ERI 组相比，PHI 患者的损伤更严重（损伤严重程度评分（ISS）33（9-75）比 25（9-75）；p=0.004）。PHI 组的死亡率高于 ERI 组（26.8%比 8.6%；p=0.001）。当将 PHI 和 ERI 患者按性别、年龄、体重指数和 ISS 进行匹配（每组 N=50）时，PHI 组的总胃内容物和空气量分别为 496（59-1915）和 119（0-997）mL，ERI 组分别为 429（36-1726）和 121（4-1191）mL（p=0.85 和 p=0.98）。PHI 组有 8.1%的患者出现提示吸入的影像学表现，而 ERI 组有 4.3%的患者出现这种表现（p=0.31）。在出现肺部 CT 表现的患者中，胃内空气量为 194（0-1355）mL，而在无肺部 CT 表现的患者中为 98（1-1902）mL（p=0.08）。
结论
在严重创伤患者中，源自食物、液体和空气的总胃容量预计约为 400-500mL。由空气引起的胃扩张很常见，但通常与院前气道管理无关。胃内的空气量似乎与吸入风险相关。需要进一步的研究，特别是针对困难气道管理情况下的患者。
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