在紧急情况下,术前全胃评估主要依靠临床判断。我们的主要目标是与胃点护理超声(PoCUS)相比,评估临床判断在急诊患者术前评估全胃的诊断性能。我们的次要目标是确定紧急患者中与PoCUS饱腹相关的危险因素。
我们在医院领导了一项前瞻性观察性研究,2016年1月至7月。接受紧急手术的成年患者符合资格。胃超声解剖改变的患者,减少胃内容物的干预措施,不可能的侧卧被排除。在胃PoCUS测量前收集临床判断和胃饱腹的危险因素。超声检查的全胃由固体含量或液体量≥1.5mlkg-1定义。通过敏感性评估诊断性能,特异性,准确度,阳性和阴性预测值。
196例患者的临床和PoCUS全胃患病率分别为29%和27%,分别。阳性和阴性预测值分别为42%(95%CI:32.3-52.6%)和79%(95%CI:74.9-83.4%),分别。55%的PoCUS全胃患者在临床上被误诊。PoCUS全胃与腹部或妇科产科手术相关(OR3.6,95%CI:1.5-8.8,P<0.01),但与禁食时间无关。发病后6小时固体禁食规则的阳性固体摄入量与PoCUS低危胃含量相关(OR0.4,95%CI:0.2-0.9,P=0.03)。
临床判断显示,在紧急手术患者中,诊断为胃饱腹症的表现较差至中等。胃PoCUS应用于评估该人群的饱腹风险。
In urgent situations, preoperative full stomach assessment mostly relies on clinical judgment. Our primary objective was to assess the diagnostic performance of clinical judgment for the preoperative assessment of full stomach in urgent patients compared to gastric point-of-care ultrasound (PoCUS). Our secondary objective was to identify risk factors associated with PoCUS full stomach in urgent patients.
We led a prospective observational study at our Hospital, between January and July 2016. Adult patients admitted for urgent surgery were eligible. Patients with altered gastric sonoanatomy, interventions reducing stomach content, impossible lateral decubitus were excluded. Clinical judgment and risk factors of full stomach were collected before gastric PoCUS measurements. Ultrasonographic full stomach was defined by solid contents or liquid volume ≥ 1.5 ml kg-1. Diagnostic performance was assessed through sensitivity, specificity, accuracy, positive and negative predictive value.
The prevalence of clinical and PoCUS full stomach in 196 included patients was 29% and 27%, respectively. Positive and negative predictive values were 42% (95% CI: 32.3-52.6%) and 79% (95% CI: 74.9-83.4%), respectively. Patients with PoCUS full stomach were clinically misdiagnosed in 55% of cases. PoCUS full stomach was associated with abdominal or gynaecological-obstetrical surgery (OR 3.6, 95% CI: 1.5-8.8, P < 0.01) but not with fasting durations. Positive solid intake after illness onset with respect to 6-h solid fasting rule was associated with PoCUS low-risk gastric content (OR 0.4, 95% CI: 0.2-0.9, P = 0.03).
Clinical judgment showed poor-to-moderate performance in urgent surgical patients for the diagnosis of full stomach. Gastric PoCUS should be used to assess risk of full stomach in this population.