| Objectives : To qualitatively and quantitatively observe the nature and volume of gastric contents in patients undergoing elective surgery with ultrasound,for the purpose of evaluating the incidence of full-stomach in those patients,analyzing the causes of their full-stomach,and comparing the value of gastric ultrasound to the qualitative and quantitative analysis of gastric contents.Methods : A total of 581 patients were enrolled between November 2017 and January 2018 under the following inclusion criteria: patients undergoing elective surgery who aged above 18 with ASA grade of I-III and adhered to the ASA fasting guidelines,excluding those with anatomical abnormalities or history of esophageal or gastric surgery as well as those in the period of gestation.The gastric ultrasonic examination required two body positions,i.e.,supine position first and right lateral decubitus position later.The probe was placed in the sagittal or parasagittal position in the midline of the upper abdomen to scan the gastric antrum for its image,which was first used in a qualitative analysis to determine the presence or absence of gastric contents in the antrum and the properties of those contents if any.Subsequently,semi-quantitative observation was further conducted in the supine position and right lateral decubitus position for patients whose gastric contents appeared as liquid to identify stomachs of 0-2 grade.For stomachs of grade 1 and 2,a quantitative method was used to identify the antrum cross-sectional diameter line,which was converted by the formula and model to area and gastric capacity.And the ratio of gastric volume and body weight was calculated according to the volume of stomach.The following patient information was included:(1)Basic parameters(gender,age,height,weight,and body mass index,ASA grade),(2)Common diseases associated with delayed gastric emptying(e.g.,diabetes,gastroesophageal reflux,neurological disorders),(3)Types of surgery for patients,(4)Fasting and No-drinking time;as well asthe Outcomes:(1)Changes in anesthesia(including delayed surgery,altered anesthesia,rapid sequence intubation with general anesthesia),(2)The incidence of complications of reflux aspiration during the perioperative period.Results: A total of 581 patients were enrolled.30 Patients did not complete the ultrasonic examination,and the gastric ultrasound images of the remaining 551 patients were analyzed to show the following results: 36 patients(6.5%)had a full-stomach state,of which 4 patients(0.7%)had solid gastric contents while 32(5.8%)had liquid contents(gastric body weight ratio>1.5 ml kg-1),and 515 patients(93.4%)had empty stomach.The analysis of patients' basic information and coexisting disease status showed that the average age of patients with full stomach was significantly lower than that of patients with empty stomach;the sex ratio comparison showed that the ratio of male/female patients with full stomach was significantly higher than that of patients with empty stomach;the proportion of diabetics in patients with full stomach(16.7%)was significantly higher than that in patients with empty stomach(7.8%);no statistical differences in height,weight,BMI,fasting time,no-drinking time,ASA grade and reflux esophagitis were found.The gastric antrum cross-sectional area,gastric capacity and the ratio of gastric capacity to body weight were significantly different in patients with different gastric antrum grades(grade 0-2).As the gastric antrum grade increased,both the cross-sectional area of gastric antrum and the value of gastric capacity increased along with it;the mean level of the ratio of gastric capacity to body weight in patients with gastric antrum of grade 2 was higher than those in patients of grade 0 and 1;The percentage of patients with gastric fluid gastric body weight ratio>1.5ml/kg-1 in different antrum grading groups was significantly different.Among the 36 patients with full stomach,there were 8 cases with common diseases associated with delayed gastric emptying.29 Patients underwent changed management of anesthesia,and none of them experienced perioperative complications of reflux inhalation.Conclusion: This study shows that ultrasound technology can be used to display preoperative images of gastric antrum in most patients(93.4%)for observing the capacityof gastric antrum.The quantitative and semi-quantitative measurements used in the study fundamentally led to consistent results,i.e.,90.5% of antrum patients of grade 0and 1 basically reached the fasting standard(gastric body weight ratio?1.5 ml/kg),while9.5% of antrum patients of grade 1 and 79.3% of those of grade 2 were in a state of full stomach(gastric body weight ratio> 1.5ml/kg);although the fasting and no-drinking recommendations provided by the current fasting and no-drinking guidelines were followed,6.5% of patients undergoing elective surgery were still in a state of full stomach before anesthesia;and there was a risk of inhalation. |
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