胃内容物的评估方法
Assessment Method of the Gastric Contents
摘要: 胃内容物的肺误吸是麻醉中最可怕的并发症之一,有很高的致病率和致死率,所以胃内容物的术前评估成为麻醉过程中必不可少的环节。自主功能测试、禁食指南、鼻胃管或胃镜吸引、影像学检查对胃内容物的评估都有一定帮助,且各有优缺点。其中,胃超声在评估胃内容物上具有很大的优势,被越来越多地应用于临床。
Abstract: Pulmonary aspiration of gastric contents is one of the most terrible complications in anesthesia, with significant morbidity and mortality, so the preoperative evaluation of gastric contents becomes an essential link in the anesthesia process. Autonomic function tests, fasting guidelines, nasogastric tube or gastroscope attraction, and imaging examination are all helpful in the assessment of gastric contents, each with their own advantages and disadvantages. Among them, gastric ultrasound has great advantages in the evaluation of gastric contents and is increasingly used in clinical practice.
文章引用:李敏慧, 段光友, 黄河, 陈玉培. 胃内容物的评估方法[J]. 临床医学进展, 2024, 14(1): 2157-2164. https://doi.org/10.12677/ACM.2024.141304

参考文献

[1] Lienhart, A., Auroy, Y., Péquignot, F., et al. (2006) Survey of Anesthesia-Related Mortality in France. Anesthesiology, 105, 1087-1097. [Google Scholar] [CrossRef] [PubMed]
[2] Cotton, B.R. and Smith, G. (1984) The Lower Oesophageal Sphincter and Anaesthesia. British Journal of Anaesthesia, 56, 37-46. [Google Scholar] [CrossRef] [PubMed]
[3] Vanner, R.G., Pryle, B.J., O’Dwyer, J.P., et al. (1992) Upper Oesophageal Sphincter Pressure and the Intravenous Induction of Anaesthesia. Anaesthesia, 47, 371-375. [Google Scholar] [CrossRef] [PubMed]
[4] Harkness, G.A., Bentley, D.W. and Roghmann, K.J. (1990) Risk Factors for Nosocomial Pneumonia in the Elderly. The American Journal of Medicine, 89, 457-463. [Google Scholar] [CrossRef
[5] Ishihara, H., Singh, H. and Giesecke, A.H. (1994) Relation-ship between Diabetic Autonomic Neuropathy and Gastric Contents. Anesthesia & Analgesia, 78, 943-947. [Google Scholar] [CrossRef] [PubMed]
[6] Manchikanti, L., Colliver, J.A., Marrero, T.C., et al. (1985) Assessment of Age-Related Acid Aspiration Risk Factors in Pediatric, Adult, and Geriatric Patients. Anesthesia & Analgesia, 64, 11-17. [Google Scholar] [CrossRef
[7] Warner, M.A., Warner, M.E. and Weber, J.G. (1993) Clinical Significance of Pulmonary Aspiration during the Perioperative Period. Anesthesiology, 78, 56-62. [Google Scholar] [CrossRef] [PubMed]
[8] Javadi, H., Bayani, H., Mogharrabi, M., et al. (2015) Relation between Clinical Features and Gastric Emptying Time in Diabetic Patients. Nuclear Medicine Review—Central & Eastern Europe, 18, 3-6. [Google Scholar] [CrossRef
[9] Marrinan, S., Emmanuel, A.V. and Burn, D.J. (2014) Delayed Gas-tric Emptying in Parkinson’s Disease. Movement Disorders, 29, 23-32. [Google Scholar] [CrossRef] [PubMed]
[10] Pellegrini, C., Antonioli, L., Colucci, R., et al. (2015) Gastric Motor Dys-functions in Parkinson’s Disease: Current Pre-Clinical Evidence. Parkinsonism & Related Disorders, 21, 1407-1414. [Google Scholar] [CrossRef] [PubMed]
[11] Haj Kheder, S., Heller, J., Bär, J.K., et al. (2018) Autonomic Dysfunction of Gastric Motility in Major Depression. Journal of Affective Disorders, 226, 196-202. [Google Scholar] [CrossRef] [PubMed]
[12] Van Vlem, B., Schoonjans, R., Vanholder, R., et al. (2001) Dyspep-sia and Gastric Emptying in Chronic Renal Failure Patients. Clinical Nephrology, 56, 302-307.
[13] Wang, C., Chen, C., Wang, J., Guo, X., Deng, Y.C., Liu, L. and Zhao, C. (2022) Delayed Gastric Emptying in Nondiabetic Patients with End-Stage Kidney Disease. Renal Failure, 44, 329-335. [Google Scholar] [CrossRef
[14] Neild, P.J., Nijran, K.S., Yazaki, E., et al. (2000) Delayed Gastric Emptying in Human Immunodeficiency Virus Infection: Correlation with Symptoms, Autonomic Function, and Intestinal Motility. Digestive Diseases and Sciences, 45, 1491-1499. [Google Scholar] [CrossRef
[15] Engelhardt, T. and Webster, N.R. (1999) Pulmonary Aspiration of Gastric Contents in Anaesthesia. British Journal of Anaesthesia, 83, 453-460. [Google Scholar] [CrossRef] [PubMed]
[16] Marik, P.E. (2001) Aspiration Pneumonitis and Aspiration Pneumonia. The New England Journal of Medicine, 344, 665-671. [Google Scholar] [CrossRef
[17] Almirall, J., Boixeda, R., de la Torre, M.C., et al. (2021) Aspiration Pneumonia: A Renewed Perspective and Practical Approach. Respiratory Medicine, 185, Article ID: 106485. [Google Scholar] [CrossRef] [PubMed]
[18] (2017) Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elec-tive Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology, 126, 376-393. [Google Scholar] [CrossRef
[19] Van de Putte, P. and Perlas, A. (2014) Ultrasound Assess-ment of Gastric Content and Volume. British Journal of Anaesthesia, 113, 12-22. [Google Scholar] [CrossRef] [PubMed]
[20] Van de Putte, P., Vernieuwe, L., Jerjir, A., et al. (2017) When Fasted Is Not Empty: A Retrospective Cohort Study of Gastric Content in Fasted Surgical Patients. British Journal of Anaesthesia, 118, 363-371. [Google Scholar] [CrossRef] [PubMed]
[21] Sigmon, D.F. and An, J. (2022) Nasogastric Tube. StatPearls Publishing, Treasure Island.
[22] Bouvet, L., Mazoit, J.X., Chassard, D., et al. (2011) Clinical Assessment of the Ultrasonographic Measurement of Antral Area for Estimating Preoperative Gastric Content and Volume. Anesthesiology, 114, 1086-1092. [Google Scholar] [CrossRef
[23] Demeo, M.T. and Bruninga, K. (2002) Physiology of the Aerodigestive System and Aberrations in That System Resulting in Aspiration. Journal of Parenteral and Enteral Nutri-tion, 26, S9-S18. [Google Scholar] [CrossRef] [PubMed]
[24] Perlas, A., Mitsakakis, N., Liu, L., et al. (2013) Validation of a Mathematical Model for Ultrasound Assessment of Gastric Volume by Gastroscopic Examination. Anesthesia & Analge-sia, 116, 357-363. [Google Scholar] [CrossRef
[25] Mitteregger, T., Schwaiger, P., Kreutziger, J., et al. (2020) Computer Tomographic Assessment of Gastric Volume in Major Trauma Patients: Impact of Pre-Hospital Airway Man-agement on Gastric Air. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 28, Article No. 72. [Google Scholar] [CrossRef] [PubMed]
[26] Yeung, L., Miraflor, E., Strumwasser, A., et al. (2012) Does Gastric Volume in Trauma Patients Identify a Population at Risk for Developing Pneumonia and Poor Outcomes? Jour-nal of Surgical Research, 178, 874-878. [Google Scholar] [CrossRef] [PubMed]
[27] (2011) What Is an MRI Scan and What Can It Do? Drug and Ther-apeutics Bulletin, 49, 141-144. [Google Scholar] [CrossRef] [PubMed]
[28] Camps, G., Mars, M., Witteman, B.J.M., et al. (2018) Indirect vs Direct Assessment of Gastric Emptying: A Randomized Crossover Trial Comparing C-Isotope Breath Analysis and MRI. Neurogastroenterology & Motility, 30, e13317. [Google Scholar] [CrossRef] [PubMed]
[29] Heissam, K., Abrehart, N., Hoad, C.L., et al. (2020) Measurement of Fasted State Gastric Antral Motility before and after a Standard Bioavailability and Bioequivalence 240 ml Drink of Water: Validation of MRI Method against Concomitant Perfused Manometry in Healthy Participants. PLOS ONE, 15, e0241441. [Google Scholar] [CrossRef] [PubMed]
[30] Sauter, M., Curcic, J., Menne, D., et al. (2012) Measuring the Interaction of Meal and Gastric Secretion: A Combined Quantitative Magnetic Resonance Imaging and Pharmacokinetic Modeling Approach. Neurogastroenterology & Motility, 24, 632-638, e272-e273. [Google Scholar] [CrossRef] [PubMed]
[31] Lobo, D.N., Hendry, P.O., Rodrigues, G., et al. (2009) Gastric Emptying of Three Liquid Oral Preoperative Metabolic Preconditioning Regimens Measured by Magnetic Reso-nance Imaging in Healthy Adult Volunteers: A Randomised Double-Blind, Crossover Study. Clinical Nutrition, 28, 636-641. [Google Scholar] [CrossRef] [PubMed]
[32] Schmitz, A., Kellenberger, C.J., Liamlahi, R., et al. (2012) Residual Gastric Contents Volume Does Not Differ Following 4 or 6 h Fasting after a Light Breakfast—A Magnetic Resonance Imaging Investigation in Healthy Non-Anaesthetised School-Age Children. Acta Anaesthesiologica Scandi-navica, 56, 589-594. [Google Scholar] [CrossRef] [PubMed]
[33] Schmitz, A., Kellenberger, C.J., Neuhaus, D., et al. (2011) Fasting Times and Gastric Contents Volume in Children Undergoing Deep Propofol Sedation—An Assessment Using Magnetic Resonance Imaging. Pediatric Anesthesia, 21, 685-690. [Google Scholar] [CrossRef] [PubMed]
[34] Terkawi, A.S., Karakitsos, D., Elbarbary, M., et al. (2013) Ultrasound for the Anesthesiologists: Present and Future. Scientific World Journal, 2013, Article ID: 683685. [Google Scholar] [CrossRef] [PubMed]
[35] Hata, J., Haruma, K., Manabe, N., et al. (2007) Chapter 16. Gastric Cancer. In: Maconi, G. and Bianchi Porro, G., Eds., Ultrasound of the Gastrointestinal Tract, Medical Radiology Diag-nostic Imaging Series, Springer-Verlag, Berlin, 135-142.
[36] Ishigami, S., Yoshinaka, H., Sakamoto, F., et al. (2004) Preoperative Assessment of the Depth of Early Gastric Cancer Invasion by Transabdominal Ultrasound Sonography (TUS): A Comparison with Endoscopic Ultrasound Sonography (EUS). Hepatogastroenterology, 51, 1202-1205.
[37] Gilja, O.H., Hatlebakk, J.G., Odegaard, S., et al. (2007) Advanced Imaging and Visualization in Gas-trointestinal Disorders. World Journal of Gastroenterology, 13, 1408-1421. [Google Scholar] [CrossRef] [PubMed]
[38] Schulze, K. (2006) Imaging and Modelling of Digestion in the Stom-ach and the Duodenum. Neurogastroenterology & Motility, 18, 172-183. [Google Scholar] [CrossRef] [PubMed]
[39] Bolondi, L., Bortolotti, M., Santi, V., et al. (1985) Meas-urement of Gastric Emptying Time by Real-Time Ultrasonography. Gastroenterology, 89, 752-759. [Google Scholar] [CrossRef] [PubMed]
[40] Cubillos, J., Tse, C., Chan, V.W., et al. (2012) Bedside Ultra-sound Assessment of Gastric Content: An Observational Study. Canadian Journal of Anesthesia, 59, 416-423. [Google Scholar] [CrossRef] [PubMed]
[41] Perlas, A., Chan, V.W., Lupu, C.M., et al. (2009) Ultrasound Assessment of Gastric Content and Volume. Anesthesiology, 111, 82-89. [Google Scholar] [CrossRef
[42] Arzola, C., Carvalho, J.C., Cubillos, J., et al. (2013) Anes-thesiologists’ Learning Curves for Bedside Qualitative Ultrasound Assessment of Gastric Content: A Cohort Study. Ca-nadian Journal of Anesthesia, 60, 771-779. [Google Scholar] [CrossRef] [PubMed]
[43] Perlas, A., Davis, L., Khan, M., et al. (2011) Gastric Sonography in the Fasted Surgical Patient: A Prospective Descriptive Study. Anesthesia & Analgesia, 113, 93-97. [Google Scholar] [CrossRef
[44] Kruisselbrink, R., Arzola, C., Endersby, R., et al. (2014) In-tra- and Interrater Reliability of Ultrasound Assessment of Gastric Volume. Anesthesiology, 121, 46-51. [Google Scholar] [CrossRef
[45] Arzola, C., Perlas, A., Siddiqui, N.T., et al. (2018) Gastric Ultrasound in the Third Trimester of Pregnancy: A Randomised Controlled Trial to Develop a Predictive Model of Vol-ume Assessment. Anaesthesia, 73, 295-303. [Google Scholar] [CrossRef] [PubMed]
[46] Spencer, A.O., Walker, A.M., Yeung, A.K., et al. (2015) Ultrasound As-sessment of Gastric Volume in the Fasted Pediatric Patient Undergoing Upper Gastrointestinal Endoscopy: Development of a Predictive Model Using Endoscopically Suctioned Volumes. Pediatric Anesthesia, 25, 301-308. [Google Scholar] [CrossRef] [PubMed]
[47] Bouvet, L., Desgranges, F.P., Aubergy, C., et al. (2017) Prevalence and Factors Predictive of Full Stomach in Elective and Emergency Surgical Patients: A Prospective Cohort Study. British Journal of Anaesthesia, 118, 372-379. [Google Scholar] [CrossRef] [PubMed]
[48] Alakkad, H., Kruisselbrink, R., Chin, K.J., et al. (2015) Point-of-Care Ul-trasound Defines Gastric Content and Changes the Anesthetic Management of Elective Surgical Patients Who Have Not Followed Fasting Instructions: A Prospective Case Series. Canadian Journal of Anesthesia, 62, 1188-1195. [Google Scholar] [CrossRef] [PubMed]
[49] Van de Putte, P. and Perlas, A. (2014) Gastric Sonography in the Severely Obese Surgical Patient: A Feasibility Study. Anesthesia & Analgesia, 119, 1105-1110. [Google Scholar] [CrossRef
[50] Kruisselbrink, R., Arzola, C., Jackson, T., et al. (2017) Ul-trasound Assessment of Gastric Volume in Severely Obese Individuals: A Validation Study. British Journal of Anaes-thesia, 118, 77-82. [Google Scholar] [CrossRef] [PubMed]
[51] Bataille, A., Rousset, J., Marret, E., et al. (2014) Ul-trasonographic Evaluation of Gastric Content during Labour under Epidural Analgesia: A Prospective Cohort Study. British Journal of Anaesthesia, 112, 703-707. [Google Scholar] [CrossRef] [PubMed]
[52] Arzola, C., Perlas, A., Siddiqui, N.T. and Carvalho, J.C.A. (2015) Bedside Gastric Ultrasonography in Term Pregnant Women before Elective Cesarean Delivery: A Prospective Cohort Study. An-esthesia & Analgesia, 121, 752-758. [Google Scholar] [CrossRef
[53] Sherwin, M. and Katz, D. (2021) Using Gastric Ultrasound to Assess Gastric Content in the Pregnant Patient. BJA Education, 21, 404-407. [Google Scholar] [CrossRef] [PubMed]
[54] Delamarre, L., Srairi, M., Bouvet, L., et al. (2021) Anaesthesiolo-gists’ Clinical Judgment Accuracy Regarding Preoperative Full Stomach: Diagnostic Study in Urgent Surgical Adult Pa-tients. Anaesthesia Critical Care & Pain Medicine, 40, Article ID: 100836. [Google Scholar] [CrossRef] [PubMed]
[55] Okada, Y., Toyama, H., Kamata, K., et al. (2020) A Clinical Study Comparing Ultrasound-Measured Pyloric Antrum Cross-Sectional Area to Computed Tomography-Measured Gastric Content Volume to Detect High-Risk Stomach in Supine Patients Undergoing Emergency Abdominal Surgery. Journal of Clinical Monitoring and Computing, 34, 875-881. [Google Scholar] [CrossRef] [PubMed]
[56] Buisman, W.J., Mauritz, F.A., Westerhuis, W.E., et al. (2016) Evaluation of Gastric Volumes: Comparison of 3-D Ultrasound and Magnetic Resonance Imaging. Ultrasound in Medi-cine and Biology, 42, 1423-1430. [Google Scholar] [CrossRef] [PubMed]