机械通气患者腹内压与肠内营养喂养不耐受的相关性研究

Correlation between Intra-Abdominal Pressure and enteral feeding intolerance in Mechanical Ventilation patients

目的:分析气管插管机械通气(MV)患者腹内压(IAP)与肠内营养喂养不耐受(FI)的相关性及IAP对FI的预测价值。方法:采用描述性研究,对2016年4月至2017年1月在北京某三级甲等医院ICU病房进行治疗的110例气管插管的MV患者进行调查,于患者肠内营养开展前及之后的前3天测量患者的IAP,并评估患者EN过程中FI(肠鸣音减弱或消失、腹泻、24 h胃残余量、便秘、呕吐/返流、胃肠道出血)的发生情况。分析IAP与FI的相关性,并确定IAP预测FI发生的临界值。结果:患者FI的发生率为73.6%,其中肠鸣音减弱或消失和腹泻分别占53.6%和48.2%。相关分析结果显示IAP与FI症状的数量呈显著性正相关(P<0.05)。基线与EN前3天的IAP预测患者FI的ROC曲线下的面积分别为0.81(95%CI:0.73~0.89)和0.86(95%CI:0.79~0.93),其预测FI发生最佳临界值分别为9 mm Hg(1 mm Hg=0.133 k Pa)和11 mm Hg。结论:气管插管的MV患者,其IAP与FI呈显著性正相关,当IAP基线≥9 mm Hg及EN前3天IAP≥11 mm Hg时,应警惕患者FI的发生。

Objective： To establish the relationship between Feeding Intolerance （FI） of Early Enteral Nutrition （EEN） and Intra-Abdominal Pressure （IAP） in patients with Mechanical Ventilation （MV）. Methods： Descriptive and observational study is carried out at the critical care unit in a 3A Grade Hospital in Beijing from April 2016 to January 2017. One hundred and ten patients with MV with an expected stay of more than 5 days and scheduled to receive EEN have been involved. Their IAP before the start of EEN and the first 3 days of EEN, and the incidences of FI during the first 3 days are all recorded. Results： The incidence of FI of the patients was 73.6%, and one of the most common symptoms is absent/abnormal bowel sounds （53.6%） and diarrhea （48.2%）.Partial correlation analysis shows positive correlation between FI and IAP （P〈0.05）. The AUC under the ROC curve of baseline IAP and the average IAP during the first 3 days of EEN to predict FI are 0.81 （95% CI： 0.73-0.89） and 0.86 （95% CI： 0.79-0.93）, and the best threshold are 9 mmHg and llmmHg. Conclusion： Critically ill patients with MV face high incidence ofFI. IAP and FI are related. The baseline IAP and the average of IAP during the first 3 days of EEN could predict the occurrence of FI.