Ultrasound Measurements To Predict The Amount Of Juice For Emergency Surgery And Vomiting Occurred

Objective:To explore the use of ultrasound in measuring antral cross-sectional area (CSA) and calculating the amount of gastric juice in non-traumatic conditions, for predicting the occurrence of vomiting. Methods:1) Acquisition, data collection: Clinical cases between November 2012 and November 2014 were collected to measure CSA extraction and to analyse the biochemical test of gastric juice.2) 113 cases of emergency abdominal surgery patients gastric antral CSA were measured and the amount of gastric juice were calculated. According to the study by Bouvet et al., three groups were devided on the juice volume:group A:juice volume≤ 0.4ml/kg (defined as fasting); group B:0.4ml/kg< juice volume≤ 0.8ml/kg; group C:juice volume> 0.8ml/kg (defined as satiety).3) Patients were semi-recumbent position, and were used ultrasound system, abdominal imaging mode and the transducer C60x /5-2MHz convex array probe to probe scan the abdomen (xiphoid) next to the sagittal plane, the left lobe of the liver and the abdominal aorta as the body marker. Clockwise or counterclockwise revolving the probe light, in order to obtain a clear picture of the gastric antrum. Measure gastric antrum in the ultrasound image along the direction of the body and the head and tail back and forth direction of maximum diameter (D1 and D2), the CSA was then calculated (CSA= π×D1 ×D2/4). The amount of gastric juice was calculated based on Bouvet regression equation.4) Gastric juice extraction:first of all, choose stomach tube to extract the gastric juice, adopt silicon rubber material one-off three double cavity capsule stomach tube, the gastric tube was soft enough and was not easy to fold or distortion; Then, through into the perforated gastric canal before anesthesia as keeping patients in left side position, suction the gastric juice. Massage the patient’s upper abdomen and move the tube to get more extraction. Finally, the PH values and volumes of gastric juice were measured. In addition, the gastric tube and suction could be observed under fluorescent screen in order to correct the tube’s position. If the process encountered resistance, a syringe was used to rush the blockage by cleaning air, meanwhile not against the suction, to avoid gastric mucosa damagement. Results:1. Most patients with ultrasound confirmed the feasibility of the antrum CSA measurements. In this study,87 cases of emergency abdominal surgery patients those measured gastric juice volume with ultrasound, and then inserted gastric tube drain gastric juice, the date were divided into ultrasonic measurement group and gastric juice extraction group, observe the distal CSA detection rate of ultrasonic measurement group, compare the value of gastric juice quantity of two groups. Through the contrast, we found that the detect rate of ultrasonic measurements of the distal CSA group was 100%, and ultrasonic measurement group to measure the distal CSA and gastric juice extracting amount of gastric juice extracting difference is small, the gastric juice volume data, ultrasonic measurement is feasible for the distal CSA.2. A positive correlation between Gastric antral CSA measured prior to induction of anesthesia for emergency surgery and volume of contents of stomach was determined.1) This study selected 87 cases of patients for emergency surgery before anesthesia to measure antral CSA with ultrasound between November of 2012 and November of 2014 in our department. Antral CSA was measured in patients with five different position supine, sit-rise,Trendelenburg, left lateral and right lateral, and the difference of antral CSA was compared. It is found that antral CSA measured in half supine was maximum.2) 87 cases of emergency abdominal surgery patients with ultrasonic measurement gastric juice quantity first, and then insert gastric tube drain gastric juice, were divided into ultrasonic measurement group and gastric juice extraction group. There was small difference of gastric juice measurements between the two group.2. Antral CSA of patients fasting, satiety and 1h,3h after eating was measured using ultrasound and gastric juice was extracted. By comparison study, it is found that when fasting antral CSA and volume of stomach contents was the minimum, and when satiety antral CSA and volume of stomach contents was the maximum. With the development of time after eating, gastric antral CSA and the volume of stomach contents material had been reduced. Therefore, the gastric antral CSA and the volume of gastric contents had a positive correlation relationship.3. Antral CSA measurements before induction of anesthesia for emergency surgery could be used to determine the circumference of the probability of operative vomiting and to assess gastric residual volume> 0.8ml/kg. as the risk of aspiration standard. First,87 cases of surgical treatment of emergency patients were observed when they were sent into the operating room, cut a skin surgery and at the end of surgery for the blood pressure (BP) and heart rate (HR) and blood oxygen saturation (SpO2). The results of three time points of BP, HR, SpO2 compared were not statistically significant. In addition, the difference of the comparison between the patients with operation time, blood loss and transfusion volume was small, and had no statistical significance. Second,113 cases of patients for emergency surgery were tested ultrasonically before anesthesia induction. Gastric antral CSA was measured and gastric juice volume was calculation. Results showed: fasting patients accounted for 18.6%, satisfy patients 51.3%, and other patients 30.1%. Through comparative study, in 21 cases of the gastric juice volume≤ 0.4ml/kg group, incidence of vomiting was 9.5%; in 34 cases of the gastric juice volume 0.4≤ the gastric juice volume≤ 0.8ml/kg group, incidence of vomiting was 20.6%; in 58 cases of the gastric juice volume≥ 0.8ml/kg group, incidence of vomiting was 48.3%. Therefore, ultrasonic measurement of the antral CSA and perioperative incidence of vomiting type had a high correlation, and measurement of the antral CSA before anesthesia induction for emergency surgery could be used to determine the occurrence of perioperative vomiting. SPSS20.0 software was used for statistical analysis, and P＜0.05 has a statistically significance, It showed that the higher the amount of gastric juice was, the higher the incidence of vomiting in patients.Conclusion:By the study, ultrasonic measurement is feasible for the antral CSA, and the antral CSA and the volume of gastric contents has a positive correlation relationship. In addition, ultrasound measurement of the antral CSA and perioperative incidence of vomiting type has a high correlation, therefore, measurements of the antral CSA before anesthesia induction for emergency operation can be used to determine the occurrence of perioperative vomiting. And the higher the amount of gastric juice is, the higher the incidence of aspiration. Patients with gastric residual> 0.8ml/kg can be used as evaluate aspiration risk standard. Therefore, ultrasonic measurement of gastric juice quantity may be very useful in the prediction of vomiting for emergency surgery patients in clinical research.