重症机械通气病人超声监测的肠系膜上动脉血流速变化预测肠内营养不耐受的临床研究  

Changes in superior mesenteric artery blood flow velocity monitored by ultrasound can predict enteral nutrition intolerance in mechanically ventilated critical ill patients

作　　者：陈蓓蓓 谢琴 徐相勤 马宇敏 刘肇修[3] CHEN Bei-bei;XIE Qin;XU Xiang-qin;MA Yu-min;LIU Zhao-xiu(Intensive Care Department,the Second People's Hospital of Nantong,Jiangsu Province,Nantong 226000,Jiangsu,China;Department of Endocrinology,the Second People's Hospital of Nantong,Jiangsu Province,Nantong 226000,Jiangsu,China;Department of Gastroenterology,Affiliated Hospital of Nantong University,Jiangsu Province,Nantong 226000,Jiangsu,China)

机构地区：[1]江苏省南通市第二人民医院重症医学科,江苏南通226000 [2]江苏省南通市第二人民医院内分泌科,江苏南通226000 [3]江苏省南通大学附属医院消化内科,江苏南通226000

出　　处：《肠外与肠内营养》2024年第3期154-161,166,共9页Parenteral & Enteral Nutrition

基　　金：2019年度中国博士后科学基金第66批面上资助项目(2019M661909);江苏省自然科学基金青年基金项目(BK20200965);2021年省博后C类资助项目(2021K405C);国家自然科学基金青年基金项目(82000497)。

摘　　要：目的:探讨机械通气病人超声监测肠系膜上动脉(SMA)血流速变化对肠内营养不耐受(FI)的影响及其预测效能。方法:回顾性纳入南通市第二人民医院重症医学科2022年2月至2023年2月期间收治的108例机械通气病人的临床资料,分析肠内营养开始的第1、3、7天(D1、D3、D7)SMA血流参数及肠内营养耐受情况。研究肠内营养不耐受组和耐受组、不耐受组各亚组(轻、中、重度)病人SMA血流速参数差异;评估SMA血流参数对FI的预测价值,探索FI的风险因素,初步探究SMA血流参数与肠道屏障功能的关系。结果:D1、D3及D7耐受组病人SMA血流速参数收缩期峰值速度(PSV)及舒张末期速度(EDV)均高于不耐受组,差异均有统计学意义(P<0.05);亚组分析显示,D7随着不耐受程度逐步加重,PSV逐渐下降;D1、D3、D7 EDV随着不耐受程度逐渐加重,EDV逐渐下降,差异均有统计学意义(P<0.05);D1、D3、D7病人PSV及EDV预测FI的AUC分别为0.752(95%CI:0.660~0.830)及0.773(95%CI:0.682~0.848)、0.774(95%CI:0.683~0.849)及0.796(95%CI:0.708~0.868)、0.743(95%CI:0.650~0.822)及0.713(95%CI:0.618~0.796);D3病人PSV、去甲肾上腺素使用、血磷水平是FI的独立预后因素;肠内营养不耐受病人PSV、EDV与二胺氧化酶均呈负相关(PSV:r=-0.857,P<0.001;EDV:r=-0.795,P<0.001);PSV与脂多糖内毒素呈正相关(r=0.377,P=0.040)。结论:超声监测肠系膜上动脉血流速变化有效预测机械通气病人肠内营养不耐受。Objective:To explore the predictive value of blood flow velocity changes in superior mesenteric artery(SMA)monitored by ultrasound on feeding intolerance(FI)of enteral nutrition(EN)in mechanically ventilated ICU patients.Methods:One-hundred and eight mechanically ventilated patients in Intensive Care Department of the Second People's Hospital of Nantong from February 2022 to February 2023 were enrolled.SMA blood flow parameters and enteral nutrition tolerance were monitored on the 1st,3rd,and 7th day(D1,D3,D7)after initiation of EN.Differences in SMA blood flow parameters between tolerant and intolerant group,as well as intolerant subgroups(mild,moderate,and severe)were analyzed.The predictive value of SMA blood flow parameters for FI and the risk factors of FI were also evaluated,and the relationship between SMA blood flow parameters and intestinal barrier function were preliminarily explored.Result:The SMA blood flow velocity parameters,peak systolic velocity(PSV)and end diastolic velocity(EDV),were higher at D1,D3,and D7 in the tolerant groups compared to the intolerant group(all P<0.05).Subgroup analysis showed that as the degree of intolerance increased,PSV gradually decreased.EDV at D1,D3,and D7 also gradually decreased with the increased severity of FI(all P<0.05);The AUC of PSV and EDV predicting FI in D1,D3,and D7 patients were 0.752(95%CI:0.660~0.830)and 0.773(95%CI:0.682~0.848),0.774(95%CI:0.683~0.849)and 0.796(95%CI:0.708~0.868),0.743(95%CI:0.650~0.822)and 0.713(95%CI:0.618~0.796).respectively.PSV,norepinephrine use,and blood phosphorus levels were independent prognostic factors for FI at D3.Patients with FI showed a negative correlation between PSV,EDV,and diamine oxidase(PSV:r=-0.857,P<0.001;EDV:r=-0.795,P<0.001).Conclusion:Changes in blood flow velocity in the superior mesenteric artery by ultrasound monitoring can effectively predict enteral nutrition intolerance in mechanically ventilated patients,it might have potential clinical application values in ICU patients.

关 键 词：肠内营养不耐受 超声监测 肠系膜动脉血流 影响因素 肠道屏障 

分 类 号：R574.4[医药卫生—消化系统]