摘要
胃残余量(GRV)作为评估胃肠动力和肠内营养耐受状况的重要指标之一, 已获得长期广泛的临床应用。近年来不断有研究者质疑对危重患者常规监测GRV的临床意义, 由于重症监护病房(ICU)人群的巨大异质性, "一刀切"原则在重症患者肠内营养实践中并不理想。监测GRV的方法各有利弊, 随着超声技术等无害化监测技术获得临床广泛应用, 传统抽吸法的应用可能会越来越少。肠内营养过程管理的重点在于找出胃潴留的原因及诱因, 更多尝试从预防和消除误吸高风险因素角度及通过病理生理学机制分析加以解决, 消除各种消极阻碍因素, 积极推动"创造条件实施肠内营养"的理念。作为重症营养管理团队, 需要重视肠内营养管理文化的不断改进并合理运用多样化的管理策略, 这也许比监测GRV更加重要。
Gastric residual volume(GRV)has been widely used in clinical practice for a long time as an essential indicator of gastrointestinal motility and enteral nutrition tolerance.Recent studies have questioned the rationality of monitoring GRV routinely in critically ill patients.A"one size fits all"principle is not an optimal solution in the clinical practice of enteral nutrition in critically ill patients because of the huge heterogeneity of the intensive care unit(ICU)population.Each method of monitoring GRV has advantages and disadvantages.With the widespread clinical application of harmless monitoring technologies such as ultrasound,the gastric suctioning method maybe used less and less.The management of enteral nutrition focuses on identifying the factors and triggers of gastric retention,attempting to solve them from the perspective of prevention and elimination of high-risk factors for aspiration and analysis of pathophysiological mechanisms,eliminating all negative hindering factors,and actively promoting the concept of"creating conditions for enteral nutrition".As a critical nutrition management team,it is necessary to pay attention to the continuous improvement of enteral nutrition management culture and rationally use diversified management strategies,which may be more important than monitoring GRV.
作者
俞祎婧
刘文明
Yu Yijing;Liu Wenming(Department of Critical Care Medicine,the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University,Changzhou 213000,Jiangsu,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2022年第7期764-768,共5页
Chinese Critical Care Medicine
基金
吴阶平医学基金会临床科研专项(320.6750.2022-02-20)。
关键词
危重症
肠内营养
胃残余量
Critically ill
Enteral nutrition
Gastric residual volume
