腹内压监测辅助IAH/ACS高危病人行肠内营养支持治疗

Monitoring intra-abdominal pressure to assist enteral nutrition supporting treatment for patients with high risk of IAH/ACS

目的 :评价腹内压监测在辅助IAH/ACS高危病人行肠内营养支持治疗中的应用价值。方法 :选取2016年8月~2017年2月上海长征医院综合ICU需进行肠内营养支持治疗的、且存在IAH/ACS高危风险的病人,随机分为实验组(零感~?尿动力监控仪监测腹内压,n=60)和对照组(传统水柱法监测腹内压,n=60),比较两组病人肠内营养相关并发症、胃残余量、腹内压及营养液喂养情况等。结果 :实验组的肠内营养并发症发生率较对照组明显降低(7.92%vs 28.33%,P<0.01;平均胃残余量、腹内压均低于对照组[(50.12±10.66)ml vs(101.54±25.81)ml、(8.28±2.35)cm H_2O vs(12.36±2.51)cm H_2O,P<0.05],实验组病人肠内营养液目标喂养完成率及达标时间较对照组均有改善[88.3%vs.71.7%、(2.94±0.78)d vs.(3.78±1.02)d,P<0.05]。结论 :腹内压监测可辅助IAH/ACS高危病人进行肠内营养支持治疗,降低病人胃肠道相关并发症发生率,提高病人营养耐受程度,改善肠内营养目标喂养情况,具有临床推广应用价值。

Objective： To evaluate the practical application of intra-abdominal pressure（IAP） monitoring product in patients receiving enteral nutrition（EN） and with high risk of intra-abdominal hypertension/abdominal compartment syndrome（IAH/ACS）. Methods： Patients receiving EN treatment from Changzheng hospital were randomly divided as experimental group（measuring IAP with pressure monitoring product, n = 60） and control group（measuring IAP with conventional method, n = 60）. The clinical data of gastrointestinal complications, gastric residual volume, IAP and completion of target infusions were collected and analyzed. Results： The incidence of gastrointestinal complications in experimental group patients significantly decreased comparing with the control group patients（7.92% vs 28.33%, P 〈 0.01）. The levels of gastric residual volume and IAP in experimental group patients were lower than those in control group patients[（50.12 ± 10.66） ml vs.（101.54 ± 25.81） ml,（7.17 ± 1.84） cm H2O vs（12.36 ± 2.51） cm H2O, P 0.05]. Moreover, The experimental group patients had a shorter period to achieve target infusions and higher proportion of completion treatments [88.3% vs 71.7%,（2.94 ± 0.78）d vs（3.78 ± 1.02）d, P 〈 0.05）]. Conclusion： As utilizing pressure monitoring products to assist EN treatment for patients with high risk of IAH/ACS could achieve lower incidence of gastrointestinal complications, excellent EN tolerance, and improve target feeding, its clinical application should be extended.