应用超声动态监测胃残余量指导重症机械通气患者早期营养治疗逐步达标  

The dynamic monitoring of gastric residual volume by ultrasound was used to guide the early nutritional treatment of patients with severe mechanical ventilation to gradually achieve the standard

作　　者：杨红晓[1] 马金兰 陈静[2] 李桂芳[1] 丁欢[1] Yang Hongxiao;Ma Jinlan;Chen Jing;Li Guifang;Ding Huan(Department of Critical Care Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China;Department of Rehabilitation Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China)

机构地区：[1]宁夏医科大学总医院重症医学科,银川750004 [2]宁夏医科大学总医院康复医学科,银川750004

出　　处：《中华危重病急救医学》2024年第2期172-177,共6页Chinese Critical Care Medicine

基　　金：宁夏回族自治区重点研发计划项目(2022BEG03125)。

摘　　要：目的探讨床旁超声动态监测胃残余量(GRV)在重症机械通气患者早期肠内营养达到不同目标能量的应用价值。方法采用前瞻性随机对照研究方法,纳入2022年7月至12月入住宁夏医科大学总医院重症医学科42例机械通气患者。按随机数字表法将患者分为传统回抽胃液法评估GRV指导肠内营养组(对照组,22例)和床旁超声评估GRV指导肠内营养组(试验组,20例)。收集两组患者一般资料,动态观察超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、中性粒细胞百分比(Neut%)、降钙素原(PCT)、淋巴细胞绝对值(LYM)、前白蛋白(PA)、视黄醇结合蛋白(RBP)等临床指标。比较两组炎症、感染、免疫、营养指标以及返流/误吸、呼吸机相关性肺炎(VAP)发生率,并进一步比较两组患者启动肠内营养第1、3、5天分别达到目标能量25%、50%及70%的喂养比例。结果①两组患者性别、年龄、体重指数(BMI)、机械通气时间、以及入院时急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、重症营养风险评分(NUTRIC)差异均无统计学意义,具有可比性。②启动肠内营养第1天,两组间感染、炎症、免疫和营养指标比较差异无统计学意义;启动肠内营养第3天,试验组hs-CRP低于对照组,LYM、PA高于对照组〔hs-CRP(mg/L):129.60±75.18比185.20±63.74,LYM:1.00±0.84比0.60±0.41,PA(mg/L):27.30±3.66比22.30±2.55,均P<0.05〕;启动肠内营养第5天,试验组hs-CRP、Neut%、PCT低于对照组,LYM、PA高于对照组〔hs-CRP(mg/L):101.70±54.32比148.40±36.35,Neut%:(85.50±7.66)%比(92.90±6.01)%,PCT(μg/L):0.7(0.3,2.7)比3.6(1.2,7.5),LYM:1.00±0.68比0.50±0.38,PA(mg/L):27.10±4.57比20.80±3.51,均P<0.05〕。两组间各时间点IL-6、RBP比较差异均无统计学意义。③启动肠内营养第3天、第5天试验组分别达到50%、70%目标能量的比例明显高于对照组(70.0%比36.4%,70.0%比36.4%,均P<0.05)。④启动肠内营养第5�Objective To explore the application value of dynamic monitoring of gastric residual volume(GRV)in achieving different target energy in severe mechanical ventilation patients.Methods A prospective randomized controlled study was conducted.Forty-two patients with mechanical ventilation admitted to the department of critical care medicine of General Hospital of Ningxia Medical University from July to December 2022 were enrolled.According to the random number table method,patients were divided into GRV guided enteral nutrition by traditional gastric juice pumpback method(control group,22 patients)and GRV guided enteral nutrition by bedside ultrasound(test group,20 patients).General data were collected from both groups,and clinical indicators such as hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),neutrophil percentage(Neut%),procalcitonin(PCT),absolute lymphocytes(LYM),prealbumin(PA),and retinol-binding protein(RBP)were dynamically observed.Inflammation,infection,immunity,nutritional indicators,and the incidence of reflux/aspiration,ventilator-associated pneumonia(VAP)were compared between the two groups,and further compared the proportion of patients with respectively to reach the target energy 25%,50%,and 70%on days 1,3,and 5 of initiated enteral nutrition.Results①There were no significant differences in gender,age,body mass index(BMI),duration of mechanical ventilation,and acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA),severe nutritional risk score(NUTRIC)at admission between the two groups,indicating comparability.②On day 1 of initiated enteral nutrition,there were no significant differences in infection,inflammation,immunity and nutrition indicators between the two groups.On day 3 of initiated enteral nutrition,the hs-CRP in the test group was lower than that control group,LYM and PA were higher than those control group[hs-CRP(mg/L):129.60±75.18 vs.185.20±63.74,LYM:1.00±0.84 vs.0.60±0.41,PA(mg/L):27.30±3.66 vs.22.30±2.55,all P<0.05]

关 键 词：床旁超声 胃残余量 机械通气 肠内营养 目标能量 

分 类 号：R459.7[医药卫生—急诊医学]