本文關(guān)鍵詞： 床邊超聲法 胃竇單切面面積 危重癥患者 胃排空功能　出處：《皖南醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討超聲測量胃竇橫切面面積(ACSA)判斷胃容量的可行性,為臨床評估危重癥患者誤吸風險,指導制定合理的腸內(nèi)營養(yǎng)方案提供參考。方法:選取皖南醫(yī)學院弋磯山醫(yī)院和南陵縣醫(yī)院2015年10月到2016年12月期間的住院患者。(1)研究超聲監(jiān)測胃殘余量的價值。選擇入住重癥醫(yī)學科(ICU)的危重患者15例,鼻飼腸內(nèi)營養(yǎng)液6h后,采用床邊超聲檢測半臥位時患者胃竇橫切面面面積。同時通過回抽胃內(nèi)容物法,分析回抽量與胃竇面積的關(guān)系。(2)超聲評估胃容量與胃竇面積的一致性。選擇骨科、婦科等外科手術(shù)患者19例,禁食禁飲至少8小時,取半臥位行床邊超聲檢查,隨后予患者胃內(nèi)200ml溫水,比較空腹狀態(tài)和充盈狀態(tài)胃竇橫截面積的變化。中位數(shù)法確定胃液體潴留的篩查陽性界值,并基于胃竇的面積,通過先前已經(jīng)被證實的Bouvet公式和Perlas公式計算胃容量GV1和GV2,篩選通過超聲監(jiān)測評估胃液體容量適合國人的計算公式。結(jié)果:(1)對回抽量、年齡、身高、體重、ACSA、體表面積等相關(guān)因素進行Pearson相關(guān)性分析,顯示胃腸內(nèi)營養(yǎng)液回抽量與胃竇橫截面積之間存在正相關(guān)關(guān)系(r=0.907,P=0.000),調(diào)整后R2=0.809;以胃內(nèi)回抽量為Y,以胃竇橫截面積為X,進行回歸分析顯示,得回歸方程:Y=26.019X-108.825,對方程檢驗,回歸方程有效(F=60.374,P=0.000),有統(tǒng)計學意義。(2)胃竇液體充盈狀態(tài)和空腹狀態(tài)橫截面積成正相關(guān)(r=0.760,P=0.000),充盈后ACSA中位數(shù)為1075 mm~2,提示ACSA大于1075 mm~2時,胃內(nèi)液體容量大于200ml。根據(jù)ACSA計算不同公式時GV1、GV2分別為189.89±22.59 ml和183.11±180.37 ml,配對t檢驗,兩公式間差異無統(tǒng)計學意義(P0.05),但GV2的離散程度較GV1明顯增大。結(jié)論:(1)超聲測量ACSA判斷胃殘留量具有可行性,鼻飼腸內(nèi)營養(yǎng)時ACSA與胃殘留量成正相關(guān)。(2)ACSA 1075 mm~2可作為胃液體潴留的篩查陽性界值�；贏CSA應用Bouvet公式計算預測國人胃內(nèi)液體容量,有利于指導危重患者腸內(nèi)營養(yǎng)的實施。
[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 鹵22.59ml and 183.11 鹵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.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R459.7

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