Department of Anesthesiology, the Second Affiliated Hospital of Zunyi Medical University, Intersection of Xinglong Avenue and Xinpu Avenue, Zunyi, 563000, Zunyi, China.
Department of the Second Clinical College, the Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.
BMC Anesthesiol. 2024 Sep 6;24(1):317. doi: 10.1186/s12871-024-02688-2.
Perioperative reflux aspiration presents a grave concern during sedation or general anesthesia, particularly when solid gastric contents prompt acute upper respiratory obstruction, potentially resulting in fatal consequences for patients. Currently, there are limited means for promptly assessing solid gastric contents in clinical settings. Therefore, this study examined the efficacy of ultrasound assessment for solid gastric contents, offering a rapid and non-invasive approach for early detection and decision-making regarding interventions.
The study included 400 patients scheduled for upper endoscopy procedures, which encompassed both gastroscope and gastroscope combined colonoscopy examinations with sedation. Ultrasound scanning of the antrum was performed while patients were positioned semi-sitting or in the right lateral decubitus (RLD) posture. The evaluation of solid gastric contents relied on direct visual observation during endoscopy. Gastric volume measurement occurred subsequent to endoscopic suction of gastric contents. Receiver operating characteristic curves were utilized to assess the effectiveness of ultrasonography in discerning solid contents.
Seven patients undergoing gastroscope with sedation were found to have solid gastric contents. The sensitivity, specificity, positive predictive value, and negative predictive value of the ultrasound qualitative evaluation of solid contents were 85.7%, 99%, 60%, and 99.7%, respectively.
Solid stomach contents can be evaluated qualitatively with reasonable accuracy using ultrasonography. Additionally, in patients undergoing upper endoscopy and assessed to have solid gastric contents with ultrasound, administration of mild sedation is recommended.
www.chictr.org.cn (ChiCTR2100048994); registered 19/07/2021.
围手术期反流性误吸在镇静或全身麻醉期间是一个严重的问题，尤其是当固体胃内容物引起急性上呼吸道梗阻时，可能对患者造成致命后果。目前，临床上评估固体胃内容物的方法有限。因此，本研究旨在评估超声评估固体胃内容物的效果，为临床早期发现和干预提供一种快速、非侵入性的方法。
本研究纳入了 400 例拟行上消化道内镜检查的患者，其中包括胃镜和胃镜联合结肠镜检查，并在镇静下进行。患者取半坐或右侧卧位时，对胃窦进行超声扫描。通过内镜直接观察来评估固体胃内容物。在进行内镜抽吸胃内容物后，对胃容量进行测量。采用受试者工作特征曲线评估超声对固体内容物的诊断效能。
在接受镇静胃镜检查的 7 例患者中发现存在固体胃内容物。超声定性评估固体内容物的敏感性、特异性、阳性预测值和阴性预测值分别为 85.7%、99%、60%和 99.7%。
超声可对固体胃内容物进行定性评估，且具有一定的准确性。对于行上消化道内镜检查且超声评估存在固体胃内容物的患者，建议给予轻度镇静。
www.chictr.org.cn（ChiCTR2100048994）；注册日期 2021 年 7 月 19 日。
