床旁超声胃窦运动指数指导ICU机械通气危重患者肠内营养的应用价值

目的 评价超声胃窦单切面法测定胃窦运动指数在危重患者肠内营养实施中的应用价值.方法 收集2015年6月1日至2016年3月1日ICU接受机械通气的危重患者74例,根据随机数字表法,分为回抽胃液法监测胃残余量组（对照组）和床边超声测定胃窦运动指数组（观察组）各37例.两组患者均留置鼻胃管且使用瑞代营养液经营养泵持续泵入,18h/d,连续观察7d.比较两组患者在肠内营养耐受性、喂养中断率、完全肠内营养情况、白蛋白水平、操作时间及预后相关指标.结果 对照组反流发生率及中断发生率显著多于观察组,而腹泻、误吸发生率比较差异无统计学意义（P〈0.05）.观察组完全肠内营养人数显著多于对照组,观察组白蛋白水平显著高于对照组.两组患者呼吸机相关性肺炎（VAP）发生率、ICU住院时间、机械通气时间、住院病死率比较差异无统计学意义（P〉0.05）.结论 超声测定胃窦运动指数法增加热量和蛋白质的摄入量,减少反流及中断的发生,减少护士的操作时间,值得在临床推广应用.

Objective To evaluate the application value of MI in the implementation of EN in critically ill patients. Methods 74 critically ill patients underwent mechanical ventilation in the ICU were collected from June 1, 2015 to March 1, 2016. According to the random number table method, they were divided into a gastric juice method tbr monitoring the gastric residual volume group （ control group ） and a bedside ultrasound for measuring the gastric antrum movement index g-roup （ observation group ） , each group was 37 cases.In both groups, the nasogastric tube was indwelled and the Ruidai nutrient solution was continuously pumped by the nntrient pump for 18 h/d for 7 days. The enteral nutrition tolerance, feeding interruption rate, complete enteral nutrition, albumin level, operation time, and prngnosis-related indicators were compared between the two groups. Results The incidence and interruption of the return flow of the control group during the observation period were significantly higher than that of the study group, and the incidence of diarrhoea was not statistically significant （ P〈0.05 ） . The total number of patients in the study group was significantly higher than that in the control group, and the level of albumin was significantly higher than that in the control gronp. There was no significant difference in the incidence of ventilator-associated pneumonia （ VAP ） , ICU length of stay, mechanical ventilation time, and in-hospital mortality rate between the two groups （ P〉0.05 ） . Conclusion Ultrasonic determination of MI method increases the intake of heat and protein, reduces the occun＇ence of backflow and interruption, reduces the operation time of nurses, and is worthy of clinical application.