床旁胃肠超声联合肠内营养耐受性评分在中重症急性胰腺炎患者营养治疗中的作用  

Role of bedside gastrointestinal ultrasound combined with enteral nutrition tolerance score in the nutritional treatment of patients with moderate and severe acute pancreatitis

作　　者：何聪[1] 王显雷[2] 付优[1] 申丽旻[1] 杜全胜[1] HE Cong;WANG Xianlei;FU You;SHEN Limin;DU Quansheng(Department of Intensive Care Unit,Hebei General Hospital,Shijiazhuang 050051,China;不详)

机构地区：[1]河北省人民医院重症医学科,石家庄050051 [2]河北省胸科医院结核三病区

出　　处：《山东医药》2022年第19期24-27,共4页Shandong Medical Journal

基　　金：河北省卫生健康委员会科技计划项目(20200741)。

摘　　要：目的探讨床旁胃肠超声联合肠内营养耐受性评分在中重症急性胰腺炎患者营养治疗中的作用。方法选择中重症急性胰腺炎患者54例,随机分为观察组和对照组各27例。观察组应用床旁胃肠超声联合肠内营养耐受性评分指导肠内营养治疗,对照组根据胃残余量及肠内营养耐受性评分指导肠内营养治疗。对比两组首次置入鼻肠管成功率、置管成功时间、肠内营养开始时间、达到70%目标喂养量时间及96 h达到70%目标喂养量比例,并发症发生情况,住ICU时间及28 d病死例数。结果观察组21例进行鼻肠管置入,超声引导下首次置管成功18例(85.7%);对照组20例进行鼻肠管置入,盲插法首次置管成功13例(65%)。两组首次置管成功率比较差异无统计学意义(P>0.05)。观察组、对照组置管成功时间分别为2(1,3)、3(2,4)h,观察组置管成功时间短于对照组(P<0.05)。观察组肠内营养开始时间、达到70%目标喂养量时间及96 h达到70%目标喂养量比例分别为2.5(2.1,3.0)、2.3(1.7,3.0)d及20例(74.1%);对照组分别为2(1.7,2.5)、3.5(2.4,5.0)及12例(44.4%)。观察组肠内营养开始时间、达到70%目标喂养量时间均短于对照组(P均<0.05),96 h到达70%目标喂养量比例高于对照组(P<0.05)。观察组发生反流、误吸、营养中断分别为2、1、2例;对照组发生反流、误吸、营养中断分别为3、1、3例。两组并发症发生情况比较差异无统计学意义(P>0.05)。观察组住ICU时间及28 d病死例数分别为7.9(6.5,10)d、3例;对照组住ICU时间及28 d病死例数分别为12(5.8,13)、4例。两组住ICU时间及28 d病死例数比较差异无统计学意义(P均>0.05)。结论床旁胃肠超声联合肠内营养耐受性评分可为中重症急性胰腺炎患者提供个体化的营养治疗方案,缩短了其达到目标喂养量的时间。Objective To investigate the effect of bedside gastrointestinal ultrasound combined with enteral nutritional tolerance score in nutritional therapy for patients with moderate and severe acute pancreatitis.Methods Fifty-four cases of moderate and severe acute pancreatitis were randomly divided into the observation group and control group,with 27 cases in each.Enteral nutrition treatment was guided by bedside gastrointestinal ultrasound combined with enteral nutrition tolerance score in the observation group,while enteral nutrition treatment was guided by gastric residual volume(GRV)and enteral nutrition tolerance score in the control group.The success rate of the first naso-intestinal tube insertion,the successful time of the tube insertion,the start time of enteral nutrition,the time to reach the 70% target feeding amount,and the proportion of reaching the 70% target feeding amount at 96 h were observed in the two groups.Complications such as regurgitation,aspiration and nutritional interruption rate were observed.The ICU stay time and the number of 28-day mortality of the two groups were monitored.Results In the observation group,21 cases underwent naso-intestinal catheter implantation,and 18 cases(85.7%)were successfully placed for the first time under ultrasound guidance.In the control group,20 cases underwent nasal and intestinal catheterization,and 13 cases(65%)were successfully placed for the first time by blind catheterization.There was no significant difference in the success rate of first catheterization between the two groups(P>0.05).The successful catheterization time of the observation group and control group was 2(1,3)and 3(2,4)h,respectively,and the successful catheterization time of the observation group was shorter than that of the control group(P<0.05).In the observation group,the time to start enteral nutrition,the time to reach 70%target feeding amount and the proportion of reaching the 70% target feeding amount at 96 h were 2.5(2.1,3.0),2.3(1.7,3.0)days,and 20 cases(74.1%),respectively;those i

关 键 词：中重症急性胰腺炎 肠内营养治疗 床旁胃肠超声 肠内营养耐受性评分 

分 类 号：R657.5[医药卫生—外科学]