腹内压对胃潴留的影响及其临界值观察

Effect of intra-abdominal pressure on gastric retention and observation of its critical value

目的通过监测患者腹腔内压变化观察其对胃潴留的影响,寻找胃潴留时的腹内压值,观察胃潴留与急性生理学与慢性健康状况评分系统Ⅱ(APACHE-Ⅱ)评分的相关性。方法选取2014年8月-2016年11月入住该院重症监护病房的患者,留置导尿管、鼻胃管及给予鼻饲能全力液(1 ml:1 kcal,500 ml/瓶1 kcal=4.184kj)。腹内压监测时无使用胃肠动力药物及长期使用镇静药物。用膀胱测压法测腹内压,4次/d,鼻饲后1和12 h后各测2次,每次取平均值。营养方式为鼻胃管微泵加温(37~40℃)鼻饲,第1天速度50 ml/h,如果通畅,第2天及之后为50~100 ml/h,如不畅改为50 ml/h。如果出现胃潴留,即时测腹内压2次,取平均值。潴留后第2天则鼻饲温开水观察何时通畅。对所有患者进行APACHE-Ⅱ评分。结果(1)腹内压平均值为(9.8±1.5)mm Hg。腹腔内高压发生率为64.7%。胃潴留发生率为33.6%。与非腹内高压组比较,腹内高压组胃潴留发生率高(P<0.05);(2)胃潴留时腹内压平均值为(17.4±0.4)mm Hg;(3)胃潴留组与非潴留组APACHE-Ⅱ评分平均值分别为(19.7±3.6)和(12.0±2.5)分,两组比较,胃潴留组的APACHE-Ⅱ评分更高(P<0.05)。结论 ICU中患者腹内压常升高,腹内压升高至(17.4±0.4)mm Hg时鼻胃管鼻饲能全力液患者易出现胃潴留,胃潴留组的APACHE-Ⅱ评分较非胃潴留组高。

Objective To observe the effect of intra-abdominal pressure(IAP)on gastric retention in criticallyill patients through dynamic monitoring,to find the critical value of intra-abdominal pressure in patients with gastric retention,and observe the correlation between gastric retention and APACHE-II score.Methods Critically-ill patients in the ICU of Wenzhou Pelople’s Hospital were selected between August 2014 and November 2016 with indwelling catheter,nasogastric tube and given nasal feeding of enteral nurtritional suspension(TPF,1 kcal/1 ml,500 ml/bottle).No gastrointestinal motility drug nor long-time sedative drug was given during intra-abdominal pressure monitoring.Intra-abdominal pressure was detected by bladder manometer 4 times a day,twice 1 hour after feeding and twice 12 hours after feeding,the average value was recorded.Intra-gastric nutrient through indwelling nasogastric tube was fed with enteral nutrition micropump(37-40℃).On the first day,the infuse speed was 50 ml/h,and from the second day on(if unobstructed)the infusion proceeded at a speed of 50-100 ml/h,if obstructed,the speed was maintained at 50 ml/h.If gastric retention was observed,intra-abdominal pressure was instantly measured twice,the average value was recorded.On the next day after gastric retension,the patients were fed with warm water to observe the time of gastric patency.APACHE-II scores were assessed to all cases.Results The average value of intra-abdominal pressure was(9.8±1.5)mmHg.The incidence of intra-abdominal hypertension was 64.7%.The gastric retention rate was 33.6%.Compared to the non intra-abdominal hypertension group,the incidence of gastric retention was higher in the intra-abdominal hypertension group(P<0.05).The average value of IAP in the patients with gastric retention was(17.4±0.4)mmHg.The average APACHE-II score was(19.7±3.6)in the gastric retention patients,and(12.0±2.5)in the non-gastric retention patients,the former was significantly higher than the latter(P<0.05).Conclusions The IAP in the critically-ill patients in ICU usual increases.When IAP increases to(17.4±0.4)mmHg,the patients who are fed with TPF(1 kcal/1 ml,500 ml/bottle)through nasal tube are prone to gastric retention.The patients with gastric retention have higher average APACHE-II score.