胃部超声检查对剖宫产前后胃窦部变化的评估
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摘要
目的通过胃部超声检查方法观察剖宫产前后胃窦部变化的情况并比较皮肤到胃窦部中心距离及腹主动脉前壁到胃窦部中心距离的变化。方法选择拟行择期剖宫产手术的产妇47例,年龄18～35岁,麻醉方法均采用蛛网膜下腔阻滞。胃部超声检查记录产妇剖宫产前后仰卧位和右侧卧位下胃窦部横截面积(cross-sectional area, CSA)和Perlas评分,同时测量皮肤到胃窦部中心和腹主动脉前壁到胃窦部中心的距离变化情况。结果与剖宫产前比较,剖宫产后仰卧位下胃窦部CSA明显减小(P=0.001),但右侧卧位下胃窦部CSA差异无统计学意义。剖宫产前后仰卧位和右侧卧位下Perlas评分差异均无统计学意义。与剖宫产前比较,剖宫产后皮肤到胃窦部中心距离和腹主动脉前壁到胃窦部中心的距离明显缩短(P<0.05)。结论剖宫产后仰卧位下胃窦部CSA减小,妊娠晚期胃窦部CSA不能用于胃内容物的定量评估,但胃内容物的定性评估不会受到影响。
Objective To investigate the changes of the gastric antrum before and after cesarean section, and to compared the distance between the skin and the centre of the gastric antrum, and the distance between the anterior wall of the abdominal aorta and the centre of the gastric antrum by gastric ultrasonography. Methods Forty-seven maternal undergoing cesarean section were selected, aged from 18 to 35, and anesthesia was performed with subarachnoid block. The antral cross-sectional area(CSA) and Perlas scores before and after cesarean section in supine position and right lateral position were recorded, and the changes of distance between the skin and the centre of the gastric antrum, and the distance between the anterior wall of the abdominal aorta and the centre of the gastric antrum were measure at the same time. Results Compared with before cesarean section, the antral CSA measured in supine position decreased significantly(P = 0.001), but there was no statistically significant difference when the woman was right lateral position after cesarean section. There was no significant difference in Perlas scores between the supine position and the right lateral position before and after cesarean section. Compared with before cesarean section, the distance between skin and gastric antrum, and the distance between gastric antrum and the wall of aorta were significantly shortened after cesarean section(P < 0.05). Conclusion The gastric antrum CSA decreased in supine position after cesarean section, the gastric antrum CSA of third trimester of pregnancy can not be used for quantitative evaluation of gastric contents, but qualitative evaluation of gastric contents were not affected.
Objective To investigate the changes of the gastric antrum before and after cesarean section, and to compared the distance between the skin and the centre of the gastric antrum, and the distance between the anterior wall of the abdominal aorta and the centre of the gastric antrum by gastric ultrasonography. Methods Forty-seven maternal undergoing cesarean section were selected, aged from 18 to 35, and anesthesia was performed with subarachnoid block. The antral cross-sectional area(CSA) and Perlas scores before and after cesarean section in supine position and right lateral position were recorded, and the changes of distance between the skin and the centre of the gastric antrum, and the distance between the anterior wall of the abdominal aorta and the centre of the gastric antrum were measure at the same time. Results Compared with before cesarean section, the antral CSA measured in supine position decreased significantly(P = 0.001), but there was no statistically significant difference when the woman was right lateral position after cesarean section. There was no significant difference in Perlas scores between the supine position and the right lateral position before and after cesarean section. Compared with before cesarean section, the distance between skin and gastric antrum, and the distance between gastric antrum and the wall of aorta were significantly shortened after cesarean section(P < 0.05). Conclusion The gastric antrum CSA decreased in supine position after cesarean section, the gastric antrum CSA of third trimester of pregnancy can not be used for quantitative evaluation of gastric contents, but qualitative evaluation of gastric contents were not affected.
引文
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[7] Sharma G,Jacob R,Mahankali S,et al.Preoperative assessment of gastric contents and volume using bedside ultrasound in adult patients:a prospective,observational,correlation study.Indian J Anaesth,2018,62(10):753-758.
[8] Chun R,Baghirzada L,Tiruta C,et al.Measurement of intra-abdominal pressure in term pregnancy:a pilot study.Int J Obstet Anesth,2012,21(2):135-139.
[9] Arzola C,Perlas A,Siddiqui NT,et al.Bedside gastric ultrasonography in term pregnant women before elective cesarean delivery:a prospective cohort study.Anesth Analg,2015,121(3):752-758.
[10] Bouvet L,Bellier N,Gagey-Riegel AC,et al.Ultrasound assessment of the prevalence of increased gastric contents and volume in elective pediatric patients:a prospective cohort study.Pediatr Anesth,2018,28(10):906-913.
[2] Beck CE,Witt L,Albrecht L,et al.Ultrasound assessment of gastric emptying time after a standardised light breakfast in healthy children:a prospective observational study.Eur J Anaesthesiol,2018,35(12):937-941.
[3] Arzola C,Cubillos J,Perlas A,et al.Interrater reliability of qualitative ultrasound assessment of gastric content in the third trimester of pregnancy.Br J Anaesth,2014,113(6):1018-1023.
[4] Ohashi Y,Walker JC,Zhang F,et al.Preoperative gastric residual volumes in fasted patients measured by bedside ultrasound:a prospective observational study.Anaesth Intensive Care,2018,46(6):608-613.
[5] BG Dupont,J Gavory P,Lambert N,et al.Ultrasonographic gastric volume before unplanned surgery.Anaesthesia,2017,72(9):1112-1116.
[6] Arzola C,Cubillos J,Perlas A,et al.Interrater reliability of qualitative ultrasound assessment of gastric content in the third trimester of pregnancy.Br J Anaesth,2014,113(6):1018-1123.
[7] Sharma G,Jacob R,Mahankali S,et al.Preoperative assessment of gastric contents and volume using bedside ultrasound in adult patients:a prospective,observational,correlation study.Indian J Anaesth,2018,62(10):753-758.
[8] Chun R,Baghirzada L,Tiruta C,et al.Measurement of intra-abdominal pressure in term pregnancy:a pilot study.Int J Obstet Anesth,2012,21(2):135-139.
[9] Arzola C,Perlas A,Siddiqui NT,et al.Bedside gastric ultrasonography in term pregnant women before elective cesarean delivery:a prospective cohort study.Anesth Analg,2015,121(3):752-758.
[10] Bouvet L,Bellier N,Gagey-Riegel AC,et al.Ultrasound assessment of the prevalence of increased gastric contents and volume in elective pediatric patients:a prospective cohort study.Pediatr Anesth,2018,28(10):906-913.