床旁彩超监测GRV在危重症患者肠内营养中的应用价值  

Application value of bedside color ultrasound to monitor gastric residual volume in enteral nutrition of critically ill patients

作　　者：俞荷花 蒋卓娟 李阳洋 雷培培 丁菊飞 Yu Hehua;Jiang Zhuojuan;Li Yangyang;Lei Peipei;Ding Jufei(Shanghai Changzheng Hospital(Second Hospital of the Naval Medical University),Shanghai 200001,China)

机构地区：[1]上海长征医院(海军军医大学第二附属医院),上海200001

出　　处：《首都食品与医药》2024年第19期132-134,共3页Capital Food Medicine

基　　金：上海长征医院护理科研基金课题(NO:CZYY-HLZ910)。

摘　　要：目的探究床旁彩超评估危重症患者胃残余量(GRV)及肠内营养(EN)喂养不耐受的临床价值。方法回顾性分析上海长征医院收治的46例危重症患者作为研究对象,患者均需进行腹部CT检查,并在CT检查后30min进行床旁超声监测,记录其胃窦截面积。全部纳入患者使用VOLUME-Work Flow软件描记腹部CT胃壁轮廓计算GRV。通过Pearson相关性分析评估患者胃窦截面积与三个体位(半坐位、平卧位和右侧卧位)及GRV的关系。对比喂养耐受组和喂养不耐受组患者床旁彩超监测的胃窦截面积情况,分析不同体位监测胃窦截面积对EN喂养不耐受的预测价值。结果通过Pearson相关性分析显示,GRV与半坐位(r=0.528)、平卧位(r=0.594)、右侧卧位(r=0.603)时的胃窦截面积呈显著正相关(P<0.01)。喂养耐受组在半坐位、平卧位和右侧卧位时床旁彩超监测胃窦截面积均小于喂养不耐受组,P<0.05。ROC曲线分析发现,三种体位的胃窦截面积预测喂养不耐受的曲线下面积(AUC)、敏感度、特异度分别为:0.811、91.6%、72.2%(半坐位时),0.828、74.5%、93.1%(平卧位时),0.852、93.3%、74.8%(右侧卧位时)。结论床旁彩超可以较好监测危重症患者的GRV,并能预测EN期间喂养不耐受情况,从而及时调整和优化EN方案,值得临床采纳。Objective To study the clinical value of bedside color Doppler ultrasound to assess gastric residual volume(GRV)and enteral nutrition(EN)feeding intolerance in critically ill patients.Methods Retrospective analysis of 46 critically ill patients admitted to our hospital as research objects,all patients need to undergo abdominal CT examination,and 30 minutes after CT examination,bedside ultrasound monitoring,recording the cross-sectional area of gastric antrum.The VOLUME-Work Flow software was used to trace the abdominal CT gastric wall profile and calculate GRV in all patients.The relationship between the cross-sectional area of gastric antrum and three postures(semi-seated,supine and right lateral)and GRV was analyzed by Pearson correlation analysis.The cross-sectional area of gastric antrum monitored by color ultrasound was compared between the feeding tolerance group and the feeding intolerance group,and the predictive value of different body positions monitoring cross-sectional area of gastric antrum for EN feeding intolerance was analyzed.Results Pearson correlation analysis showed that GRV was significantly positively correlated with the cross-sectional area of antrum in semi-seated position(r=0.528),supine position(r=0.594)and right lateral position(r=0.603)(P<0.01).The cross-sectional area of gastric antrum monitored by color ultrasound in the semi-seated,supine and right lateral position in the feeding tolerance group was significantly smaller than that in the feeding intolerance group(P<0.05).ROC curve analysis showed that the area under the curve(AUC),sensitivity and specificity of the cross-sectional area of gastric antrum for the prediction of feeding intolerance of the three postures were,0.811,91.6%,72.2%(Semi-seated),0.828,74.5%,93.1%(recumbent),0.852,93.3%,74.8%(right-sided).Conclusion Bedside color ultrasound can better monitor GRV in critically ill patients and predict feeding intolerance during EN,so as to timely adjust and optimize EN program,which is worthy of clinical adoption.

关 键 词：床旁彩超 胃残余量 肠内营养 危重症 

分 类 号：R473.5[医药卫生—护理学]