The Predictive Value Of Bedside Ultrasound To Assess The Risk Of Aspiration In Patients With Hepatitis B Cirrhosis

Objective:To explore the predictive value of bedside ultrasound to assess the risk of aspiration for patients with hepatitis B cirrhosis during perianesthesia.Content:Utilized bedside ultrasound to scan antrum for patients with non-hepatitis B cirrhosis and hepatitis B cirrhosis,compared antral cross-sectional area between two groups of patients.Injected different volume of saline into stomach for patients with hepatitis B cirrhosis and measured their corresponding CSA,analyzed the correlation between CSA and the corresponding volume of gastric juice for these patients.Measured CSA of patients with hepatitis B cirrhosis in the supine position and inspected 340 mm~2 cut-off value to assess the risk of aspiration whether was suitable for these patients,and quested a new cut-off value.Explore the predictive value of the bedside ultrasound to assess the aspiration risk for patients with hepatitis B cirrhosis in the supine position.Method:(1)Respectively selected 100 cases for patients with non-hepatitis B cirrhosis and hepatitis B cirrhosis to perform ordinary gastroscopy examination from June 2017 to October 2017,aged 18 to 75 years old,ASA grade I~III,BMI<40kg/m~2.Patients were monitored heart rate?blood pressure?pulse oxygen saturation,collected all patients'past medical history?related laboratory liver function index?fasting time and nature of last food.Before accepting gastroscopy examination,utilized bedside ultrasound to real-time scan the antrum of patients with hepatitis B cirrhosis in the supine position.(2)Selected 200 patients with hepatitis B cirrhosis,accepting ordinary gastroscopy examination from October 2017 to December 2017.Randomly divided 200 patients above into five groups.After accepting gastroscopy examination,utilized gastroscopy to extremely negative pressure suctioning fluid and gases from stomach,and then fast injected different volume of 0mL?50mL?100mL?150mL?200mL saline into patients'stomach.Then utilized bedside ultrasound to measure antral cross-sectional area for patients with hepatitis B cirrhosis in the supine position,analyzed correlation between antral cross-sectional area and volume of gastric juice.(3)Selected 200 patients with hepatitis B cirrhosis,accepting ordinary gastroscopy examination from January 2018 to March 2018.Utilized bedside ultrasound to scan the antrum of these patients in the supine position,measured antral cross-sectional area.After accepting ordinary gastroscopy examination,utilized gastroscopy to negative pressure suctioning completely all fluid from stomach and recorded volume of gastric juice.Inspected 340 mm~2 cut-off value of antral cross-sectional area measured in the supine position to assess the risk of aspiration whether was suitable for patients with hepatitis B cirrhosis,quested a new cut-off value and analyzed the related factors of the change.Result:(1)Compared with fasting patients with non-hepatitis B cirrhosis,antral cross-sectional area was larger in patients with hepatitis B cirrhosis.(2)There was a significant positive correlation between antral cross-sectional area and gastric juice volume in patients with hepatitis B cirrhosis in the supine position,the correlation coefficient was 0.752.(3)The 530.5mm~2 cut-off value of antral cross-sectional area measured in the supine position is more suitable to predict the risk of aspiration for patients with hepatitis B cirrhosis.(4)There was a negative correlation between antral cross-sectional area and choline-esterase,total protein,albumin,a positive correlation between antral cross-sectional area and total bilirubin,direct bilirubin and coagulation time.Multivariate analysis showed that each unit of cholinesterase increased,antral cross-sectional area measured in the supine position decreased by 0.035 units.Conclusion:(1)Antral cross-sectional area of patients with hepatitis B cirrhosis is larger than peoples'with non-hepatitis B cirrhosis by bedside ultrasound.(2)The correlation between the antral cross-sectional area and volume of gastric juice is linear positive correlation in patients with hepatitis B cirrhosis.(3)Qualitatively and quantitatively assessing gastric contents is feasible by bedside ultrasound for patients with hepatitis B cirrhosis.