Clinical Study On The Application Of Gastric Antrum Ultrasound In Anesthesia Evaluation

Objective:Dynamic gastric antrum ultrasound was used to evaluate gastric empyema and monitor the occurrence of gastric distension under different ventilation modes during anesthesia induction.Objective is to explore the clinical significance of gastric antrum ultrasound in the application of anesthesia evaluation.Methods:Selection in August 2017 to June 2018 in jiangsu university hospital in gastrointestinal surgery marked the digestive tract tumor surgery of 96 cases of patients,ASA I-?level.Patients were divided into gastric emptying group and delayed gastric emptying group according to the status of gastric emptying assessed by ultrasound before anesthesia induction on the day of operation.Gender,age,tumor location,tumor size,preoperative comorbidities,preoperative serum albumin level,previous surgical history,BMI,and gastric emptying status of the patients after6h of fasting and drinking one day before surgery were collected,and univariate and multivariate analyses were performed on the related factors that might affect gastric emptying delay.Selected in July 2018 to December 2018 in jiangsu university affiliated hospital liver surgery,laparoscopic gallbladder surgery in 160 cases of patients,ASA?-?level,were randomly divided into experimental group M?mask ventilation aftergiving nondepolarizing agent?group and the control group P?nondepolarizing agent before mask ventilation?,at the same time will be divided into two groups of patients with M1,M2,M3,M4 group and P1,P2,P3,P4,respectively adopt the following mask ventilation mode:Anesthetists manually controlled by experience,pressure-controlled10cmH₂O,pressure-controlled 15cmH₂O and pressure-controlled 20cmH₂O.The ventilation frequency of all groups was 18 times/min,and the ventilation time was2min.After conventional fasting and drinking,all patients were given ultrasonic measurements of upper and lower gastric antrum diameter D₁ and left and rightgastric antrum diameter D₂ before and after anesthetized mask ventilation,and the cross-sectional area of gastric antrum was calculated according to the formula CSA=?D₁*D₂*??/4.Gastric antrum CSA?S₁?before anesthesia induction,gastric antrum area CSA?S₂?after mask ventilation,gastric flatulence during mask ventilation,and vomiting score within 24h after surgery were recorded.Results:1.96 cases of clinical scheme implementation ERAS in patients with preoperative carbohydrate drink 2h,3 patients for not drinking carbohydrates in accordance with the stipulated time,the result is not included in the statistical analysis,more than 93 regular colorectal cancer surgery patients with stomach drink 400 ml carbohydrate before anesthesia,a total of 14 cases of patients with delayed gastric emptying,rate of 15%.The occurrence of delayed gastric emptying was statistically significant in gender,tumor location in gastric outflow tract,and delayed gastric emptying after 6h of fasting and drinking before surgery.2.?1?Among the 160 enrolled patients,after mask ventilation,a total of 52patients developed gastric distension,with an incidence of 32.5%.There was no significant difference in the incidence of gastric distension between group M and group P?P>0.05?.There was no significant difference in the incidence of gastric distension between the groups of M and P?P>0.05?.There were significant differences in the incidence of gastric distension under four mask ventilation modes in the M group,and the difference was statistically significant in the M4>M3>M2>M1?P<0.05?.There were significant differences in the incidence of gastric distension under four mask ventilation modes in the P group,and there were statistically significant differences in the P4>P3>P2=P1?P<0.05?.?2?Gastric antrum CSA after mask ventilation was greater than that before mask ventilation,and the difference was statistically significant?P<0.05?.There was no statistically significant difference in gastric antrum CSA changes between group M and group P after mask ventilation?P>0.05?,but there was a statistically significant difference between the two groups when pressure control was applied to 15cmH2O?P<0.05?.The difference of four mask ventilation modes in group M was statistically significant?P<0.05?.Among them,there were differences between M1 group and M4group and M2 group and M4 group?P<0.05?.The difference of four mask ventilation modes in group P was statistically significant?P<0.05?.Among them,there were differences between group P1 and P3,group P2 and P3,and group P2 and P4?P<0.05?.?3?There was no significant difference in the incidence of vomiting between group M and group P at 24h after the operation of the four mask ventilation modes?P>0.05?.There was no statistically significant difference in the incidence of vomiting among the four ventilation modes at 24h after operation in group M?P>0.05?.There was no statistically significant difference between the four ventilation modes in the P group in the incidence of vomiting at 24h after surgery?P>0.05?.Conclusion:1.The tumor is located in the gastric outflow tract and the delay of gastric empygation after 6h of fasting and drinking before surgery is a high risk factor for gastric empygation delay in patients with ERAS after drinking carbohydrates before surgery.The clinical implementation should be based on its influencing factors to avoid and reduce the risk of anesthesia induction period.2.During the anaesthesia induction period of laparoscopic cholecystectomy,gastric distension and cross-sectional area of gastric antrum before and after mask ventilation were observed.The incidence of gastric distension and the change of gastric antrum CSA were not significantly affected by the use of muscle relaxant before mask ventilation.Ventilation mode has a great influence on the incidence of gastric distension and gastric antrum:the incidence of gastric distension in patients with manual ventilation mode is significantly lower than that of pressure-controlled ventilation,and the incidence of gastric distension in pressure-controlled mode tends to increase with the increase of pressure control target.