急性胃肠损伤分级诊治策略在机械通气合并腹胀患者营养支持中的应用及预后分析  

Application and prognosis analysis of graded diagnosis and treatment strategy for acute gastrointestinal injury in nutritional support for patients with mechanical ventilation complicated with abdominal distension

作　　者：陈妙莲[1] 刘惠娇 阮宗发 毛凯红[1] 李建伟[1] CHEN Miaolian;LIU Huijiao;RUAN Zongfa;MAO Kaihong;LI Jianwei(Department of Critical Care Medicine,Zhongshan People's Hospital,Guangdong,Zhongshan 528400,China)

机构地区：[1]广东省中山市人民医院重症医学科,广东中山528400

出　　处：《中国医药科学》2021年第11期227-231,共5页China Medicine And Pharmacy

摘　　要：目的探讨急性胃肠损伤(AGI)分级诊治策略在机械通气合并腹胀患者营养支持中的应用及预后分析。方法选择2020年1—6月中山市人民医院重症医学科收治的机械通气24 h后进行腹胀评估其中存在胃肠功能障碍的患者90例,依据是否应用AGI分级诊治策略指导营养支持方案分为AGI分级诊治组46例和对照组44例。AGI分级诊治组根据AGI分级标准对患者腹胀程度进行分级,并根据分级处理意见对患者实施腹胀干预及营养支持方案,对照组则由临床医生按照患者腹胀程度经验性实施营养支持方案。统计和比较两组D1肠内营养喂养率、D7肠内营养摄入量及达标率、前白蛋白水平、淋巴细胞绝对值,以及两组机械通气时间、ICU停留时间、继发感染等并发症发生率。结果AGI分级诊治组D1肠内营养喂养率明显高于对照组(P<0.05),D7肠内营养摄入量及达标率高于对照组(P<0.05),D7前白蛋白水平及淋巴细胞绝对值明显高于对照组(P<0.05),AGI分级诊治组机械通气时间明显短于对照组(P<0.05),但ICU停留时间两组比较,差异无统计学意义(P>0.05)。两组在继发感染(肺部感染、导管相关性感染)发生率上AGI分级诊治组明显低于对照组(P<0.05)。结论AGI分级诊治策略可使机械通气合并腹胀患者早期接受肠内营养和达到目标肠内营养量,能够改善患者营养状况及免疫状态,缩短机械通气时间,降低继发感染等并发症发生率,为机械通气合并腹胀患者的营养支持治疗提供参考依据。Objective To investigate the application of graded diagnosis and treatment strategy for acute gastrointestinal injury(AGI)in nutritional support and the prognosis analysis of patients with mechanical ventilation combined with abdominal distension.Methods A total of 90 patients with abdominal distension who were evaluated as gastrointestinal dysfunction after 24 hours of mechanical ventilation in the Department of Critical Care Medicine of Zhongshan People's Hospital from January to June,2020 were included in this study.According to whether AGI grading diagnosis and treatment strategy was used to guide nutritional support scheme,they were divided into two groups:46 cases in the AGI grading diagnosis and treatment group and 44 cases in the control group.In the AGI grading diagnosis and treatment group,the degree of abdominal distension was graded according to the AGI grading standard,and the patients were given abdominal distension intervention and nutritional support programs according to the grading treatment opinions,while in the control group,clinicians empirically implemented nutritional support programs according to the degree of abdominal distension.The feeding rate of enteral nutrition in D1,the intake and compliance rate of enteral nutrition in D7,the level of prealbumin,the absolute value of lymphocytes,and the mechanical ventilation time,ICU stay time,the incidence of the secondary infection and other complications of the two groups were counted and compared.Results The feeding rate of enteral nutrition in D1 was significantly higher in the AGI grading diagnosis and treatment group than that in the control group(P<0.05),the intake and compliance rate of enteral nutrition in D7 were higher than that in the control group(P<0.05),the level of prealbumin and absolute value of lymphocytes in D7 were significantly higher than that in the control group(P<0.05),the mechanical ventilation time in AGI grading diagnosis and treatment group was significantly shorter than that in the control group(P<0.05),but there w

关 键 词：机械通气 腹胀 急性胃肠损伤 营养支持 

分 类 号：R573[医药卫生—消化系统]