床旁超声在机械通气患者管饲营养治疗中的价值  

Value of bedside ultrasound in tube feeding nutritional treatment in patients with mechanical ventilation

作　　者：季林玉 单琳莉 陆胜 姜岱山 陈天喜[3] 吉云兰[3] 祁雷[3] 沈雁波[3] 黄中伟[3] 沈艳[3] JI Linyu;SHAN Linli;LU Sheng;JIANG Daishan;CHEN Tianxi;JI Yunlan;QI Lei;SHEN Yanbo;HUANG Zhongwei;SHEN Yan(Nantong Municipal Maternal and Child Health Care Hospital,Nantong,Jiangsu 226000,China;Nantong University,Nantong,Jiangsu 226001,China;Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China)

机构地区：[1]江苏省南通市妇幼保健院,226000 [2]南通大学,江苏南通226001 [3]南通大学附属医院,江苏南通226001

出　　处：《重庆医学》2021年第8期1347-1351,共5页Chongqing medicine

基　　金：中国医师协会2017年睿意(睿E)急诊医学研究专项基金项目(R2017005)。

摘　　要：目的探讨床旁超声在人工气道患者管饲营养治疗中的应用价值。方法选择2018年5月至2019年9月收住南通大学附属医院急诊重症病房并需要机械通气的重症患者158例,应用床旁胃窦超声(试验组)、胃潴留量(对照组)评估入院即刻、后续每6小时的胃蠕动功能,用于指导管饲肠内营养治疗方案的制订及调整。比较两组患者入院7 d内胃肠道反应、营养支持的疗效及预后。结果与对照组比较,试验组可以显著降低喂养不耐受的程度(P=0.001),改善入院1周内前清蛋白水平的变化(41.00 g/L vs.28.00 g/L,P<0.001),降低补充性肠外营养支持的比例(41.2%vs.11.5%,P<0.001),最终显著缩短机械通气时间(7.00 d vs.5.50 d,P<0.001)和重症监护病房(ICU)住院时间(14.00 d vs.11.00 d,P<0.001)。结论胃窦超声指标能更精准地判断胃蠕动和排空情况,有利于管饲肠内营养治疗方案的制订和调整,缩短因常规以胃潴留暂停肠内营养的时间,尽快达到目标喂养需求和能量供应,缩短机械通气时间和ICU住院时间。Objective To explore the application value of bedside ultrasound in tube feeding nutritional treatment of the patients with artificial airway.Methods A total of 158 critically ill patients requiring mechanical ventilation in the emergency intensive care unit of the Affiliated Hospital of Nantong University from May 2018 to September 2019 were selected.The bedside gastric antrum ultrasound(experimental group)and gastric residual volume(GRV,control group)were used to evaluate the gastric peristaltic function immediately after admission and per subsequent every 6 h for guiding the scheme and adjustment of tube feeding enteral nutritional treatment.The gastrointestinal reactions and nutritional support effect and prognosis status were compared between the two groups within 7 d after admission.Results Compared with the control group,the experimental group could significantly reduce the degree of feeding intolerance(P=0.001),improve the pre-albumin level within one week after admission(41.00 vs.28.00 g/L,P<0.001),decrease the proportion of supplemental parenteral nutrition(41.2%vs.11.5%,P<0.001),and eventually and significantly shorten the duration of mechanical ventilation(7.00 vs.5.50 d,P<0.001)and length of ICU stay(14.00 vs.11.00 d,P<0.001).Conclusion The gastric antrum ultrasound index can more accurately judge the gastric peristalsis and emptying situation,which is conducive to the formulation and adjustment of the tube feeding nutritional treatment scheme,shorten the duration of conventional enteral nutrition suspension due to gastric retention,and achieve the target feeding demand and energy supply as soon as possible and shorten the duration of mechanical ventilation and ICU stay.

关 键 词：超声 胃窦 肠内营养 机械通气 

分 类 号：R459.3[医药卫生—治疗学]