摘要
目的探讨胃超声在急诊骨折清创术中的应用价值。方法选取2022年1月到11月嘉兴大学附属第二医院急诊骨折清创手术患者200例,年龄在18~60岁之间,首先基于禁食禁饮时间评估误吸风险,并制定初步麻醉方案,随后用胃超声分别在平卧位及右侧卧位下对胃内容物进行评估,并依据Perlas分级标准将患者分为低风险(Perlas 0级和Perlas 1级)和高风险(Perlas 2级)。将两种方法收集的数据分为时间组和超声组,采用χ^(2)检验评估两种方法误吸高风险率差异以及诱导方案(常规诱导、快速序贯诱导、推迟手术)差异,术中反流误吸和术中及术后低氧血症等并发症的发生情况。结果超声组判定胃内容物误吸高风险率高于时间组[47.5%(95/200)比33.5%(67/200),χ^(2)=8.13,P<0.05];超声组指导的麻醉方案调整率高于时间组[39%(78/200)比27.5%(55/200),χ^(2)=8.572,P<0.05]。200名患者中仅1例发生反流误吸,4例患者发生术后低氧血症。结论术前胃超声检查可精准识别急诊骨折患者胃内容物误吸风险,提高传统时间法遗漏的高风险患者检出率,优化麻醉决策。
Objective To evaluate the clinical utility of gastric ultrasound in emergency fracture debridement surgery.Methods A total of 200 patients(aged 18-60 years)undergoing emergency fracture debridement at the Second Affiliated Hospital of Jiaxing University from January to November 2022 were enrolled.Initial aspiration risk assessment was performed based on fasting duration(time-based method),and a preliminary anesthesia plan was formulated.Subsequently,gastric ultrasound(ultrasound-based method)was used to assess gastric contents in both supine and right lateral decubitus positions.Patients were classified as low-risk(Perlas grade 0 or 1)or high-risk(Perlas grade 2)according to the Perlas grading scale.Data from the two methods were categorized into the time-based group and ultrasound-based group.Theχ^(2)test was used to compare differences in high-risk aspiration rates,anesthesia induction strategies(routine induction,rapid sequence induction,or delayed surgery),and complications such as intraoperative reflux/aspiration and perioperative hypoxemia.Results The ultrasound-based group demonstrated a significantly higher high-risk aspiration rate than the time-based group[47.5%(95/200)vs.33.5%(67/200),χ^(2)=8.13,P<0.05].Similarly,the anesthesia plan adjustment rate was significantly higher in the ultrasound-based group than in the time-based group[39%(78/200)vs.27.5%(55/200),χ^(2)=8.572,P<0.05].Among all 200 patients,only one case of reflux/aspiration and 4 cases of postoperative hypoxemia were observed.Conclusion Preoperative gastric ultrasound enhances the accurate identification of aspiration risk in emergency fracture patients,significantly improves the detection of high-risk cases missed by the traditional time-based method,and optimizes anesthesia decision-making.
作者
张梁
吴新伟
裴大庆
周红梅
Zhang Liang;Wu Xinwei;Pei Daqing;Zhou Hongmei(Department of Anesthesiology,the Second Affiliated Hospital of Jiaxing University,Jiaxing 314000,China)
出处
《中华实验外科杂志》
2025年第7期1378-1380,共3页
Chinese Journal of Experimental Surgery
基金
嘉兴市科技计划项目基金(2022AD30008)。
关键词
四肢骨折手术
胃超声
Perlas分级
误吸
Limb Fracture Surgery
Gastric ultrasound
Perlas classification
Aspiration
