肠内营养后胃潴留的神经疾病重症患者近期临床结局

Analysis of short-term clinical outcomes of critically ill neurosurgical patients with gastric retention after enteral nutrition through gastric intubation

目的探讨神经疾病重症患者肠内营养后胃潴留的好发时间及近期临床结局。方法采用连续入组、方便抽样法,选取2009年3月—2011年3月在首都医科大学宣武医院神经外科ICU行肠内营养支持的重症患者204例,应用注射器每6小时抽吸胃内残留液(采用B超定位胃管的位置),当残留液≥200 ml时定义为胃潴留,观察14 d。记录胃潴留发生的时间,比较有、无胃潴留患者进入、转出ICU时的病情及近期临床结局。结果①神经疾病重症患者胃潴留的发生率为58.3%(119/204),其中88.2%(105/119)发生在肠内营养治疗后1周内。②胃潴留组和非胃潴留组进入ICU时GCS为7±4、11±4,急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)分别为20±8、13±7;转出ICU时两组患者的GOS分别为2.6±1.2、4.1±0.8,差异均有统计学意义,P<0.001。③胃潴留组患者较非胃潴留患者肺部感染增加23.2%(53.8%,30.6%);ICU住院中位数时间延长4.4 d(14.9 d,10.5 d);病死率增加29.4%(29.4%,0).结论肠内营养治疗后1周内为神经疾病重症患者胃潴留的高发时间,其并发肺部感染的概率较高,ICU住院时间延长,预后相对不良。

Objective To investigate the peak onset time of gastric retention in neurosurgical critically ill patients receiving enteral feeding through gastric intubation and the subsequent short-term clinical outcmnes. Methods Two hundred and four consecutive neurosurgical intensive care unite （NICU） pa- tients receiving enteral feeding were selected by using convenience sampling method from March 2009 to March 2011. The gastric residual volumes of food were measured with syringe every 6 hours, and gastric retention was defined when the residual volume of food ≥200 ml. The patients were observed for 14 days. The oeeurrence of gastric retention and the clinical outcomes of the patients were recorded. Results The incidence of gastric retention in NICU patients was 58.3% （ 119/204）, of which 88.2% （105/119） occurred within one week ＇after initiation of enteral nutrition. There were significant differences between the patients with gastric retention and those without gastric retention in terms of GCS before entering NICU （7±4 vs 11 ±4 ）, APACHEⅡ score （20±8 vs 13±7） and GCS when exiting NICU （2.6±1.2 vs 4.1 ±0.8）. Further more, compared to the patients without gastric retention, the patients with gastric retention had a significantly increased rate of puhnonary infection （53.8% vs 30. 6% ） , prolonged stay in NtCU （ 14.9 days vs 10.5 days） and increased rate of mortality （29.4% vs 0% ）. Conclusion Gastric retention is a common complication for NICU patients receiving enteral nutrition. The peak onset time of gastric retention is one week after enteral nutrition therapy . The occurance of gastric retention was associated with higher rate of pulmonary infection and mortality and prolonged stay in NICU. Gastric retention is an unfavorable prognostic factor for NICU patients.