摘要
目的:探讨基于床旁超声评估重症机械通气患者肠内营养(EN)胃残余量及指导临床调整EN方案的价值。方法:选取95例重症机械通气患者,均行鼻饲EN,根据胃残余量评估方法不同分为超声组和对照组。超声组48例,EN期间通过床旁超声评估胃残余量,对照组47例,EN期间采用传统注射器抽吸法评估胃残余量,两组均根据胃残余量调整EN方案。比较两组EN情况(EN达标时间、72 h达标率、EN中断率)、胃残余量评估操作时间、机械通气时间、住院时间、住院费用、并发症发生率、EN前后营养状态指标[白蛋白(ALB)、转铁蛋白(TFN)、前白蛋白(PAB)]、T细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))、肠屏障功能指标[内毒素脂多糖(LPS)、二胺氧化酶(DAO)、D-乳酸(DLA)]。结果:超声组EN达标时间短于对照组,72 h达标率高于对照组,EN中断率低于对照组(P<0.05);超声组胃残余量评估操作时间、机械通气时间、住院时间均短于对照组,住院费用少于对照组(P<0.05);超声组EN后血清ALB、TFN、PAB水平均高于对照组(P<0.05);超声组EN后血清CD3^(+)、CD4^(+)水平均高于对照组(P<0.05);超声组EN后血清LPS、DAO、DLA水平均低于对照组(P<0.05);超声组腹胀、腹泻、呕吐/反流、肠鸣音亢进或消失、呼吸机相关性肺炎发生率均低于对照组(P<0.05)。结论:重症机械通气患者行鼻饲EN期间通过床旁超声评估胃残余量操作便捷,能更准确指导EN,从而更有效改善患者营养状态、免疫功能及肠屏障功能,有助于降低并发症发生率,促进患者康复,减少住院费用。
Objective To explore the value of bedside ultrasound in the evaluation of gastric residual volume in mechanically ventilated patients and the adjustment of enteral nutrition(EN)support regimen.Methods A total of 95 patients receiving mechanical ventilation were treated with EN nasal feeding.Bedside ultrasound was used to evaluate the gastric residual volume during EN in ultrasound group(n=48),while traditional syringe aspiration was adopted in control group(n=47).The EN support regimen was adjusted according to the gastric residual volume.Two groups were compared in terms of EN condition(time-to-compliance,compliance rate in 72 h,interruption rate),time taken for gastric residual volume assessment,duration of mechanical ventilation,length of hospital stay,hospitalization cost,complication rate,nutritional status before and after EN[albumin(ALB),transfertin(TFN),prealbumin(PAB)],T cell subpopulations(CD3^(+),CD4^(+),CD8^(+)),and intestinal barrier function indicators[endotoxicity lipopolysaccharide(LPS),diamine oxidase(DAO),D-lactic acid(DLA)].Results Ultrasound group was advantageous over control group in time-to-compliance,compliance rate in 72 h,EN interruption rate,assessment time,duration of mechanical ventilation,hospital stay and hospitalization cost(P<0.05).After EN,the levels of serum ALB,TFN,PAB,CD3^(+)and CD4^(+)were higher,while the levels of serum LPS,DAO and DLA were lower in ultrasound group than in control group(P<0.05).The incidences of abdominal distension,diarrhea,vomiting/reflux,intestinal hyperactivity or disappearance and ventilator associated pneumonia in ultrasound group were all lower than those in control group(P<0.05).Conclusion During EN nasal feeding in mechanically ventilated patients,the evaluation of gastric residual volume with bedside ultrasound is convenient and can guide EN more accurately,thereby effectively improving the nutritional status,immune function and intestinal barrier function,which is helpful to reduce the incidence of complications,promote rehabilitation and reduce
作者
余小琴
王科
何琦
YU Xiaoqin;WANG Ke;HE Qi Chongqing(Emergency Medical Center,the Fourth People's Hospital of Chongqing/Chongqing University Central Hospital,Chongqing 400014,China)
出处
《中国医学物理学杂志》
CSCD
2023年第7期862-867,共6页
Chinese Journal of Medical Physics
基金
重庆市科卫联合医学科研项目(2020FYYX155)。
关键词
机械通气
肠内营养
床旁超声
胃残余量
mechanical ventilation
enteral nutrition
bedside ultrasound
residual stomach volume
