床旁超声监测胃残余量在AECOPD患者早期肠内营养中的应用  

Application of bedside ultrasounde monitoring gastric residual volume in early enteral nutrition in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：赵媛媛[1] 杜立强[2] 崔朝勃[3] 王金荣[1] 亢宏山[1] Zhao Yuanyuan;Du Liqiang;Cui Zhaobo;Wang Jinrong;Kang Hongshan(Department of Intensive Care Unit,Hengshui People′s Hospital Affiliated to Hebei Medical University,Hengshui 053000,China;Department of Gastrointestinal Surgery,Hengshui People′s Hospital Affiliated to Hebei Medical University,Hengshui 053000,China;Department of Respiratory and Critical Care Medicine,Hengshui People′s Hospital Affiliated to Hebei Medical University,Hengshui 053000,China)

机构地区：[1]河北医科大学附属衡水市人民医院重症医学科,053000 [2]河北医科大学附属衡水市人民医院胃肠外科,053000 [3]河北医科大学附属衡水市人民医院呼吸与危重症医学科,053000

出　　处：《国际呼吸杂志》2021年第13期993-997,共5页International Journal of Respiration

基　　金：河北省科技计划项目(172777108D);衡水市科技计划项目(15009)。

摘　　要：目的评估重症监护病房(ICU)应用床旁超声监测胃残余量在指导慢性阻塞性肺疾病急性加重(AECOPD)机械通气患者早期肠内营养的临床应用价值。方法前瞻性随机对照研究。选择2019年9月至2020年9月河北医科大学附属衡水市人民医院重症医学科收治的可实施早期肠内营养治疗的AECOPD有创机械通气患者90例,随机分为回抽胃液评估胃残余量组(对照组45例)和床旁超声评估胃残余量组(试验组45例)。2组均留置鼻胃管泵入肠内营养液。对照组每6 h应用50 ml注射器监测胃残余量1次,从而调整肠内营养实施方案;试验组每6 h使用床旁超声监测胃残余量1次,从而调整肠内营养实施方案。比较2组患者肠内营养不耐受指标、营养指标及预后指标的差异。结果试验组患者出现腹胀、腹泻、呕吐及2种以上症状的比例均低于对照组,差异均有统计学意义(P值均<0.05)。1周后试验组患者白蛋白、前白蛋白水平均高于对照组(P值均<0.05)。试验组72 h达到预计能量80%的比例[86.7%(39/45)]优于对照[46.7%(21/45)](P<0.05)。机械通气时间、ICU住院时间均短于对照组,差异均有统计学意义(P值均<0.05)。结论床旁超声监测胃残余量可提高AECOPD机械通气患者早期肠内营养耐受性,改善营养指标,缩短机械通气时间及ICU住院时间。Objective To evaluate the clinical value of bedside ultrasound monitoring gastric residual volume in guiding early enteral nutrition in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with mechanical ventilation in intensive care units.Methods This was a prospective randomized controlled study.From September 2019 to September 2020,90 patients from Department of Intensive Care Unit,Hengshui People′s Hospital Affiliated to Hebei Medical University with AECOPD on mechanical ventilation who could be treated with early enteral nutrition were selected and randomly divided into the gastric residual evaluation group with gastric reflux(45 cases in the control group)and the bedside ultrasound evaluation group with gastric residual volume(45 cases in the experimental group).The enteral nutrition was pumped through indwelling gastric tube in both groups.In the control group,the gastric residual volume was monitored once every 6 h with a 50 ml syringe,so as to adjust the enteral nutrition program.In the experimental group,gastric residual volume was monitored by bedside ultrasound once every 6 h,and then the enteral nutrition program was adjusted.The differences of enteral nutritional intolerance,nutrition and prognosis were compared between two groups.Results The proportion of patients with abdominal distension,diarrhea vomiting and two or more symptoms in experimental group were lower than in control group(all P<0.05).After one week of observation,Alb and PA levels of experimental group were higher than those of control group(all P<0.05).The proportion of the experimental group reaching 80%of the predicted energy at 72 h([39/45]86.7%)was better than that of the control group([21/45]46.7%)(P<0.05).Mechanical ventilation time and ICU stay time of experimental group were shorter than that of control group(P<0.05).Conclusions Bedside ultrasound monitoring of gastric residual volume can improve early enteral nutritional tolerance of patients with AECOPD with mechanical ventilation,improve nutr

关 键 词：呼吸 人工 肠内营养 胃残余量 床旁超声 

分 类 号：R563.9[医药卫生—呼吸系统]