根治性胃肠手术患者麻醉诱导前的床旁胃部超声检查：一项观察性队列研究

Gastric point-of-care ultrasonography in patients undergoing radical gastrointestinal surgery before anesthetic induction: an observational cohort study.

作者信息

Huang Siming, Cao Shumei, Sun Xia, Zhang Jun

机构信息

Department of Anesthesiology, Fudan University Shanghai Cancer Center, No.270, DongAn Road, Xuhui District, Shanghai, 200032, China.

Department of Oncology, Shanghai Medical College, Fudan University, No.270, DongAn Road, Xuhui District, Shanghai, 200032, China.

出版信息

BMC Anesthesiol. 2024 Mar 4;24(1):90. doi: 10.1186/s12871-024-02473-1.

DOI:10.1186/s12871-024-02473-1

PMID:38433227

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10910806/

Abstract

BACKGROUND

Pulmonary aspiration of gastric contents is a serious perioperative complication. Patients with gastric cancer may experience delayed gastric emptying. However, the role of qualitative and quantitative gastric ultrasound assessments in this patient population before anesthesia induction has not yet been determined.

METHODS

Adult patients with gastrointestinal cancer were recruited and examined using gastric point-of-care ultrasound (POCUS) before anesthetic induction from March 2023 to August 2023 in a tertiary cancer center. Three hundred patients with gastric cancer were conducted with POCUS prior to induction, and three hundred patients with colorectal cancer were included as controls. The cross-sectional area (CSA) of the gastric antrum and gastric volumes (GV) were measured and calculated. We determined the nature of the gastric contents and classified the antrum using a 3-point grading system. A ratio of GV to body weight > 1.5mL/Kg was defined as a high risk of aspiration.

RESULTS

In patients with gastric cancer, 70 patients were classified as grade 2 (23%, including 6 patients with solid gastric contents) and 63 patients (21%) were identified as having a high risk of aspiration. Whereas in patients with colorectal cancer, only 11 patients were classified as grade 2 (3.7%), and 27 patients (9.7%) were identified as having a high risk of aspiration. A larger tumor size (OR:1.169, 95% CI 1.045-1.307, P = 0.006), tumor located in antrum (OR:2.304, 95% CI 1.169-4.539,P = 0.016), gastrointestinal obstruction (OR:21.633, 95% CI 4.199-111.443, P < 0.0001) and more lymph node metastasis (OR:2.261, 95% CI 1.062-4.812, P = 0.034) were found to be positively while tumor site at cardia (OR:0.096, 95% CI 0.019-0.464, P = 0.004) was negatively associated with high aspiration risk in patients with gastric cancer.

CONCLUSION

The Gastric POCUS prior to induction provides an assessment of the status of gastric emptying and can identify the patients at high risk of aspiration, especially those with gastric cancer.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ( www.chictr.org.cn ) identifier: ChiCTR2300069242; registered 10 March 2023.

摘要

背景

胃内容物的肺误吸是一种严重的围手术期并发症。胃癌患者可能会出现胃排空延迟。然而，在麻醉诱导前对该患者群体进行定性和定量胃超声评估的作用尚未确定。

方法

2023年3月至2023年8月，在一家三级癌症中心招募成年胃肠道癌患者，并在麻醉诱导前使用床旁胃超声（POCUS）进行检查。300例胃癌患者在诱导前进行了POCUS检查，并纳入300例结直肠癌患者作为对照。测量并计算胃窦的横截面积（CSA）和胃容积（GV）。我们确定了胃内容物的性质，并使用三分级系统对胃窦进行分级。GV与体重之比>1.5mL/Kg被定义为误吸高风险。

结果

在胃癌患者中，70例患者被分类为2级（23%，包括6例胃内容物为固体的患者），63例患者（21%）被确定为有误吸高风险。而在结直肠癌患者中，只有11例患者被分类为2级（3.7%），27例患者（9.7%）被确定为有误吸高风险。发现更大的肿瘤大小（OR：1.169，95%CI 1.045 - 1.307，P = 0.006）、肿瘤位于胃窦（OR：2.304，95%CI 1.169 - 4.539，P = 0.016）、胃肠道梗阻（OR：21.633，95%CI 4.199 - 111.443，P < 0.0001）和更多的淋巴结转移（OR：2.261，95%CI 1.062 - 4.812，P = 0.034）与胃癌患者的误吸高风险呈正相关，而肿瘤位于贲门处（OR：0.096，95%CI 0.019 - 0.464，P = 0.004）与误吸高风险呈负相关。