急性胃肠损伤分级在重症监护病房患者早期肠内营养支持中应用的临床研究  

Clinical study of acute gastrointestinal injury classification in early enteral nutrition in patients under intensive care

作　　者：高红梅[1] 姚俊利[1] 路玲[1] 窦琳[1] 常文秀[1] 

机构地区：[1]天津市第一中心医院急救医学研究所重症医学科,300192

出　　处：《中华危重病急救医学》2014年第4期214-218,共5页Chinese Critical Care Medicine

基　　金：天津市医药卫生科技攻关课题（2010KG103）;卫生部国家临床重点专科建设项目（2011-873）

摘　　要：目的 观察急性胃肠损伤（AGI）分级标准评估重症监护病房（ICU）患者胃肠道功能障碍的可行性,并探讨以此为基础的早期肠内营养（EN）方案实施的应用价值.方法 采用前瞻性研究方法,选择2013年1月至6月天津市第一中心医院ICU收治的85例胃肠道功能障碍患者,于入住ICU后或高代谢状态发作后12～24 h内实施EN.根据AGI分级将患者分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级4组,并按AGI治疗程序进行干预.观察主要终点：7dEN摄入量达标率、病情程度和营养状态,及其与AGI分级的相关性;次要终点：48 h内开展EN的比例.结果 胃肠道功能障碍患者占同期ICU收治患者的49.42％（85/172）,Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者分别为29、28、19和9例.入ICU 1 d时,4组患者年龄、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、血清白蛋白（ALB）和前白蛋白（PA）含量比较差异均无统计学意义,基线资料均衡,有可比性.与入ICU 1 d时比较,7d时Ⅰ、Ⅱ、Ⅲ级患者APACHEⅡ评分（分）明显下降（Ⅰ级：20.48±2.45比22.59±2.06,t=-3.120,P=0.031;Ⅱ级：19.34±1.80比21.65±2.22,t=-4.316,P=0.012;Ⅲ级：20.63±1.34比23.31±1.70,t=-5.640,P=0.000）,PA含量（g/L）明显升高（Ⅰ级：24.37±6.54比10.62±7.24,t=-4.866,P=0.000;Ⅱ级：19.79±12.48比11.57±8.94,t =-2.116,P=0.031;Ⅲ级：19.15±8.43比13.78±6.59,t=-3.601,P=0.000）.入ICU 7 d时,Ⅳ级患者APACHEⅡ评分明显高于Ⅰ、Ⅱ、Ⅲ级患者（分：22.87±3.31比20.48±2.45、19.34±1.80、20.63±1.34,P＜0.05或P＜0.01）,PA含量明显低于Ⅰ、Ⅱ、Ⅲ级患者（g/L：14.02±8.70比24.37±6.54、19.79±12.48、19.15±8.43,P＜0.05或P＜0.01）;Ⅰ～Ⅳ级患者间ALB浓度差异无统计学意义（F=0.454,P=0.722）.Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者24h喂养率分别为95.4％、72.1％、52.0％和0（x2=8.310,P=0.016）;48 h喂养率分别为100.0％、83.0％、76.0％和0（x2=5.470,P=0.025）;7 d热量达标率分别为100.0％、88.7％�Objective To study the feasibility of the acute gastrointestinal injury （AGI） classification standard for evaluation of gastrointestinal function in intensive care unit （ICU） patients,and to discuss its value in administration of early enteral nutrition （EN）.Methods A perspective study was conducted.85 patients with AGI admitted to ICU of Tianjin First Center Hospital from January 2013 to June 2013 were enrolled.EN was conducted after ICU admission or within 12-24 hours after high catabolic state.The patients were divided into four groups according to the AGI classification,i.e.grade Ⅰ,Ⅱ,Ⅲ,and Ⅳ,and they were treated according to the treatment procedure for AGI.The primary end points were 7-day rate of intake of standard EN,the degree of disease and nutrition,and their correlation with AGI classification.Secondary endpoint was rate of giving EN within 48 hours.Results Gastrointestinal dysfunction patients accounted for 49.42％ （85/172） of the ICU patients,and number of patients in grade Ⅰ,Ⅱ,Ⅲ,Ⅳ were 29,28,19,9 respectively.On the first day of ICU stay,there were no statistical differences in age,acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score,serum albumin （ALB） and prealbumin （PA） among four groups,and it was demonstrated that the baseline data were comparable.APACHE Ⅱ score on the seventh day of ICU stay was significantly lower than that on the first day in grade Ⅰ,Ⅱ and Ⅲ patients （grade Ⅰ：20.48 ± 2.45 vs.22.59 ± 2.06,t=-3.120,P=0.031 ; grade Ⅱ：19.34 ± 1.80 vs.21.65 ± 2.22,t=-4.316,P=0.012; grade Ⅲ：20.63 ± 1.34 vs.23.31 ± 1.70,t=-5.640,P=0.000）,and serum PA （g/L） was significantly increased （grade Ⅰ：24.37 ± 6.54 vs.10.62 ± 7.24,t=-4.866,P=0.000; grade Ⅱ：19.79± 12.48 vs.11.57±8.94,t=-2.116,P=0.031; grade Ⅲ：19.15±8.43 vs.13.78 ± 6.59,t=-3.601,P=0.000）.On the seventh day ofICU stay,the APACHE Ⅱ score was higher in grade Ⅳ than that in grade Ⅰ,Ⅱ and Ⅲ patients （22.87 ± 3.31 vs.20.

关 键 词：急性胃肠损伤分级 早期肠内营养 胃肠道功能障碍 

分 类 号：R459.7[医药卫生—急诊医学]