床旁超声评估危重症患者肠内营养胃残余量的可行性研究  

Feasibility of using bedside ultrasound to evaluate residual gastric volume in critical ill patients with enteral nutrition support

作　　者：向成林 冯仁 米元元 黄海燕[1] 万佳[1] 胡恩华 庞志强[1] 明耀辉 Xiang Chenglin;Feng Ren;Mi Yuanyuan;Huang Haiyan;Wan Jia;Hu Enhua;Pang Zhiqiang;Ming Yaohui(Department of Critical Care Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Neurosurgery,Wuhan Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属协和医院重症医学科,武汉430022 [2]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《中国实用护理杂志》2020年第19期1446-1451,共6页Chinese Journal of Practical Nursing

基　　金：2019年华中科技大学同济医学院附属协和医院教学改革研究项目(02.03.2019.15-41)。

摘　　要：目的探讨床旁超声评估肠内营养支持患者胃残余量的可行性。方法选取2019年5—8月华中科技大学同济医学院附属协和医院ICU经胃管进行肠内营养者60例,将患者按照床号的奇偶数分组,奇数为试验组,偶数为对照组,各30例。试验组在患者实施肠内营养的0、4、8、12、16、20、24 h评估胃残余量,每个时间点先床旁超声评估胃残余量完成后立即进行注射器抽吸法经胃管抽吸胃残余量;对照组采用床旁超声评估胃残余量。比较2组患者在操作时间、不同时间点的监测结果、呕吐、腹泻以及胃肠动力药使用率、目标喂养达标时间等。结果试验组床旁超声监测胃残余量与抽吸法监测胃残余量比较差异无统计学意义(P>0.05);操作时间分别为(62.40±4.00)、(78.39±12.15)s,差异有统计学意义(t值为6.633,P<0.01)。2组在呕吐、腹泻以及胃肠动力药物使用率的比较差异无统计学意义(P>0.05)。对照组目标喂养量达标时间为(3.04±0.31)d,试验组为(4.19±0.33)d,2组比较差异有统计学意义(t值为13.42,P<0.01)。结论床旁超声可用于肠内营养支持患者胃残余量的评估,指导肠内营养实施,缩短了操作时间,减少了护士的工作量,避免肠内营养制剂污染。Objective To study the feasibility of using bedside ultrasound in evaluating gastric residual volume in critical ill patients with enteral nutrition support.Methods From May 2019 to August 2019,60 patients were selected to receive enteral nutrition via gastric tube in ICU of Union Hospital,Tongji Medical College,Huazhong University of Science and Technology.Patients were divided into the experimental group and the control group according to the odd and even number of beds,30 patients in the experimental group with odd number of beds and 30 patients in the control group with even number of beds.Gastric residual volume was evaluated at 0,4,8,12,16,20,24 h of enteral nutrition.In the experimental group,the gastric residual volume was evaluated by bedside ultrasound and syringe suction at each time point.In the control group,only bedside ultrasound was used to evaluate gastric residual volume.The results of operation time,monitoring results at different time points,diarrhea and the utilization rate of gastrointestinal motility drugs target feeding time,vomiting,were compared between the two groups.Results There was no statistical difference between the gastric residual amount monitored by ultrasound and the gastric residual amount monitored by suction(P>0.05).The operating time of bedside ultrasound monitoring was(62.40±4.00)s,the operating time of suction monitoring was(78.39±12.15)s,and the operating time of bedside ultrasound monitoring was less than that of suction(t value was 6.633,P<0.01).There was no significant difference in the rate of vomiting,diarrhea and gastrointestinal motility drugs between the two groups(P>0.05).The time to reach the target feeding amount in the control group was(3.04±0.31)d,and the time to reach the target feeding amount in the experimental group was(4.19±0.33)d.The time to reach the target feeding amount in the control group was less than that in the experimental group(t value was 13.42,P<0.01).Conclusions Bedside ultrasound can be used to evaluate the residual gastric volume of

关 键 词：超声学 肠道营养 胃肌轻瘫 重症监护 

分 类 号：R459.7[医药卫生—急诊医学] R445.1[医药卫生—治疗学]