床旁超声在危重患者胃容量监测中的应用价值

发布时间：2018-02-11 03:39

本文关键词： 床边超声法胃窦单切面面积危重症患者胃排空功能　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨超声测量胃窦横切面面积(ACSA)判断胃容量的可行性,为临床评估危重症患者误吸风险,指导制定合理的肠内营养方案提供参考。方法:选取皖南医学院弋矶山医院和南陵县医院2015年10月到2016年12月期间的住院患者。(1)研究超声监测胃残余量的价值。选择入住重症医学科(ICU)的危重患者15例,鼻饲肠内营养液6h后,采用床边超声检测半卧位时患者胃窦横切面面面积。同时通过回抽胃内容物法,分析回抽量与胃窦面积的关系。(2)超声评估胃容量与胃窦面积的一致性。选择骨科、妇科等外科手术患者19例,禁食禁饮至少8小时,取半卧位行床边超声检查,随后予患者胃内200ml温水,比较空腹状态和充盈状态胃窦横截面积的变化。中位数法确定胃液体潴留的筛查阳性界值,并基于胃窦的面积,通过先前已经被证实的Bouvet公式和Perlas公式计算胃容量GV1和GV2,筛选通过超声监测评估胃液体容量适合国人的计算公式。结果:(1)对回抽量、年龄、身高、体重、ACSA、体表面积等相关因素进行Pearson相关性分析,显示胃肠内营养液回抽量与胃窦横截面积之间存在正相关关系(r=0.907,P=0.000),调整后R2=0.809;以胃内回抽量为Y,以胃窦横截面积为X,进行回归分析显示,得回归方程:Y=26.019X-108.825,对方程检验,回归方程有效(F=60.374,P=0.000),有统计学意义。(2)胃窦液体充盈状态和空腹状态横截面积成正相关(r=0.760,P=0.000),充盈后ACSA中位数为1075 mm~2,提示ACSA大于1075 mm~2时,胃内液体容量大于200ml。根据ACSA计算不同公式时GV1、GV2分别为189.89±22.59 ml和183.11±180.37 ml,配对t检验,两公式间差异无统计学意义(P0.05),但GV2的离散程度较GV1明显增大。结论:(1)超声测量ACSA判断胃残留量具有可行性,鼻饲肠内营养时ACSA与胃残留量成正相关。(2)ACSA 1075 mm~2可作为胃液体潴留的筛查阳性界值。基于ACSA应用Bouvet公式计算预测国人胃内液体容量,有利于指导危重患者肠内营养的实施。
[Abstract]:Objective: to investigate the feasibility of evaluating gastric volume by ultrasonic measurement of antral cross-sectional area (ACSA) in order to evaluate the risk of misaspiration in critically ill patients. Methods: select the hospitalized patients from October 2015 to December 2016 to study the value of ultrasonic monitoring gastric remnant. Fifteen critically ill patients admitted to the Department of intensive Medicine (ICU) were selected, After 6 hours of nasal feeding of enteral nutrition solution, the cross-sectional area of gastric antrum was detected by bedside ultrasound in the semi-lying position. At the same time, the area of the antral cross section was measured by the method of retraction of gastric contents. Analysis of the relationship between the volume of retraction and the area of the antrum. (2) Ultrasound was used to evaluate the consistency of gastric volume with the area of the antrum. Nineteen patients with orthopedic, gynecological and other surgical operations were selected, fasting and drinking for at least 8 hours, and the bedside ultrasound was performed in the semi-lying position. The patients were then given 200ml warm water in the stomach to compare the changes of the cross-sectional area of the gastric antrum between the fasting state and the filling state. The median method was used to determine the positive value of gastric fluid retention and based on the area of the gastric antrum. The gastric volume (GV1) and gastric volume (GV2) were calculated by using the previously proven Bouvet formula and Perlas formula, and the formulas for evaluating gastric fluid volume suitable for Chinese by ultrasonic monitoring were screened. Results: 1) the amount of retraction, age, height, The correlation of body weight, body surface area and other related factors were analyzed by Pearson. The results showed that there was a positive correlation between the amount of recuperation of gastrointestinal nutrient fluid and the cross sectional area of gastric antrum. The regression analysis showed that the regression equation was Y 26.019X-108.825, and the regression equation was Y 26.019X-108.825, and the adjusted volume was 0.809, and the volume of gastric regurgitation was Y26.019X-108.825, and the regression equation was Y 26.019X-108.825, and the regression equation was Y 26.019X-108.825. There was a positive correlation between the cross sectional area of gastric antral fluid filling state and fasting state, and the median of ACSA after filling was 1075mm / 2, indicating that ACSA was more than 1075mm ~ 2:00. The gastric fluid volume was more than 200ml. The GV1GV2 was 189.89 卤22.59ml and 183.11 卤180.37ml, respectively. The difference between the two formulas was not statistically significant (P 0.05), but the dispersion of GV2 was significantly higher than that of GV1. Conclusion it is feasible to determine the gastric residue by ultrasonic measurement of ACSA. There was a positive correlation between ACSA and gastric residue during nasal feeding. ACSA 1075 mm~2 could be used as the positive value of gastric fluid retention screening. The prediction of gastric fluid volume by Bouvet formula based on ACSA was helpful to guide the implementation of enteral nutrition in critically ill patients.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R459.7

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