目的：探讨重症超声测量胃残余量（gastric residual volume,GRV）联合腹内压（intra-abdominal pressure,IAP）监测在有创机械通气患者肠内营养治疗中的应用效果。方法：选择 2023年5月至 2024年 5月就诊于我院重症医学科行有创机械通气的危重症成人患者112例作为研究对象,采用随机数字表法将患者分为对照组、研究组各56例。两组患者均启动早期肠内营养治疗并接受对症治疗,对照组患者采用注射器回抽法监测GRV,研究组患者采用重症超声监测GRV+IAP,频率为每4 h一次,观察两组患者肠内营养不耐受的发生率、免疫功能指标、营养代谢指标、入重症监护病房（ICU） 7 d内肠内营养热卡达标率、有创机械通气时间、ICU住院时间。结果：研究组患者治疗后肠内营养不耐受发生率、有创机械通气时间、ICU住院时间明显低于对照组;研究组患者入ICU 7 d内肠内营养热卡达标率高于对照组;研究组患者治疗后免疫功能指标（CD3+、CD4+、CD4+/CD8+）明显高于同期对照组;研究组患者治疗后营养代谢性指标（血清总蛋白、白蛋白、血红蛋白）明显高于同期对照组。结论：重症超声测量GRV联合IAP监测效果明显优于单纯注射器回抽法监测,可改善患者营养状态,降低肠内营养不耐受发生率,减少并发症的发生,同时对有创机械通气患者肠内营养评估及治疗提供一定参考。
Abstract
Objective to investigate the effect of gastric residual volume (GRV) and intra-abdominal pressure (IAP) measured by ultrasound on enteral nutrition in patients with invasive mechanical ventilation. Methods 112 critically ill adult patients who underwent invasive mechanical ventilation in the Intensive Care Medicine Department of our hospital from May 2023 to May 2024 were selected as the research subjects, The patients were divided into two groups using a random number table method, The control group (56 cases) and the trial group (56 cases) were given early enteral nutrition support and symptomatic treatment. The gastric residual volume (GRV) was measured by syringe withdrawal in the control group, and the gastric residual volume (GRV) was measured by ultrasound in the Study Group (GRV + IAP) at Q4H. After 7 days of admission to ICU, the rate of enteral nutritional calorie, the incidence of enteral nutritional intolerance, the indexes of immune function, inflammatory factors, nutritional metabolism, the duration of invasive mechanical ventilation and the length of stay in ICU were observed. Results the rate of enteral nutrition calorie in the study group was higher than that in the control group within 7 days after admission to ICU;The incidences of enteral nutrition intolerance, the duration of invasive mechanical ventilation and ICU stay in the study group were significantly lower than those in the control group; The levels of CD3+, CD4+, CD4+/CD8+ in the study group were significantly higher than those in the control group;The levels of proinflammatory factors (PCT, CRP, IL-6) in the study group were significantly lower than those in the control group; The nutritional metabolic indexes (ALB and hemoglobin) in the study group were significantly higher than those in the control group after treatment. Conclusion The combination of GRV measurement and IAP monitoring in severe cases is significantly more effective than simple syringe aspiration monitoring, which can improve the nutritional status of patients, reduce the incidence of enteral nutrition intolerance, and minimize the occurrence of complications. At the same time, it provides some reference for enteral nutrition assessment and treatment of patients undergoing invasive mechanical ventilation.
关键词
重症超声 /
肠内营养治疗 /
胃残余量 /
腹内压
Key words
severe ultrasound /
enteral nutrition /
gastric residua volumel /
intra-abdominal pressure
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基金
湖南省教育厅一般项目“超声引导下切割球囊联合高压球囊在AVF再发狭窄中的应用研究” （23C0009）
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