超声测定胃排空功能指导重症机械通气患者肠内营养的临床应用

Clinical application of gastric emptying measured by ultrasonography to guide enteral feeding in critical patients with mechanical ventilation

目的：探讨超声监测胃排空功能指导重症机械通气患者肠内营养的临床应用价值。方法对2014年5月至2015年11月间至我科行机械通气＞24 h且拟行肠内营养患者进行研究。入选的76例重症机械通气患者随机分为2组：传统回抽胃液组（对照组，38例）每4 h使用回抽胃液法评估胃残余量进而调整肠内营养方案；超声监测组（38例）每4 h使用超声测定胃排空或胃动力指数的方法指导肠内营养方案的制定。记录患者肠内营养达标时间、呼吸机相关性肺炎发生率、反流及腹泻次数、前白蛋白、脱机时间、ICU住院时间等指标。比较两组患者的肠内营养治疗效果。结果超声检测组肠内营养达标时间较传统对照组明显缩短，差异有统计学意义[（36.4±6.2） vs （45.1±7.8）h， P＜0.05]。超声测定组与传统对照组VAP发生率分别为13.2％（5／38）和36.8％（14／38）、肠内营养相关并发症发生率分别为28.9％（11／38）和55.3％（21／38），组间比较，差异有统计学意义（ P＜0.05）。此外，两组脱机时间[（3.6±1.1） vs （5.8±2.0） d ]、ICU 住院时间[（9.2±2.6） vs （12.3±3.7）d]比较，差异有统计学意义（P＜0．05）。结论超声测定胃排空功能可更科学地指导重症机械通气患者肠内营养方案的制定，提高肠内营养疗效，减少肠内营养相关并发症，缩短机械通气及ICU住院时间。

Objective To investigate the feasibility of gastric emptying measured by ultrasonography in guiding enteral feeding in critically ill patients receiving mechanical ventilation .Methods A total of 76 critical patients who received mechanical ventilation for over 24 h and underwent enteral nutrition admitted in our department between May 2014 and November 2015 were recruited in this study.These patients were prospectively randomized into ultrasound assessment group （ n=38） and gastric fluid withdrawing group （n=38）.The therapeutic strategy of enteral nutrition was adjusted based on gastric emptying and gastric motility index measured by ultrasonography every 4 h for the patients from the former group , while was based on the gastric residual volume by withdrawing gastric fluid every 4 h for those of the latter group .The time of reaching 80%total enteral nutrition （ TEN） , incidence of ventilator-associated pneumonia （ VAP） , numbers of reflux and diarrhea , serum level of prealbumin , time of weaning , and length of stay in ICU were recorded and compared for the efficiency of enteral nutrition .Results The time of reaching 80% TEN was significantly shorter [（36.4 ±6.2） vs （45.1 ±7.8） h, P〈0.05], and the incidences of VAP （13.2% vs 36.8%） and of enteral nutrition related complications （28.9%vs 55.3%） were significantly lower in the ultrasound assessment group than in the gastric fluid withdrawing group （P〈0.05）.What’s more, the time of weaning [（3.6 ±1.1） vs （5.8 ±2.0） d], and the length of stay in ICU [（9.2 ±2.6） vs （12.3 ±3.7 d）] were also obviously shorter in the former group （P〈0.05）.Conclusion Ultrasonography-measured gastric emptying is optimal in guiding the therapeutic strategy of enteral nutrition for the critical patients receiving mechanical ventilation , in improving the efficiency , reducing the related complications , and shortening the durations of ventilation and ICU staying .