超声评估胃残余量在神经危重症患者肠内营养中的应用

Application of point-of-care ultrasound in monitoring gastric residual volume in neurosurgical critical patients with enteral nutrition support

目的探讨床旁超声(PoCUS)评估胃残余量(GRV)在神经危重症患者肠内营养(EN)实施过程中的可行性及指导价值.方法选择2017年3月1日至2018年9月30日入住台州市中西医结合医院重症医学科(ICU)需实施EN的90例神经危重症患者,按随机数字表法将患者分为回抽胃液法评估GRV组(对照组)和PoCUS评估GRV组(研究组),每组45例.两组均经鼻胃管泵入瑞代营养液进行喂养,速度以每日目标喂养量持续18h泵入,连续给药7d.比较两组患者EN耐受情况、喂养中断发生率、每日EN液体量、达到完全EN(TEN)比例和血清白蛋白(Alb)、前白蛋白(PA)水平以及预后的差异.结果研究组反流和误吸发生率均明显低于对照组〔分别为8.9%(4/45)比24.4%(11/45)和4.4%(2/45)比17.8%(8/45),均P<0.05〕.研究组EN液体量、达到TEN比例、Alb、PA水平均明显高于对照组〔EN液体量(mL/d):944.6±277.1比783.7±230.5,达到TEN比例:86.7%(39/45)比68.9%(31/45),Alb(g/L):30.6±3.0比29.4±2.4,PA(g/L):280.5±31.8比267.7±28.4,均P<0.05〕.研究组和对照组腹泻发生率〔15.6%(7/45)比13.3%(6/45)〕、喂养中断发生率〔8.9%(4/45)比13.3%(6/45)〕、ICU住院时间(d:10.4±6.2比8.3±5.4)、院内病死率〔8.9%(4/45)比13.3%(6/45)〕比较差异均无统计学意义(均P>0.05).结论用PoCUS评估GRV来调整EN实施方案,可减少反流、误吸的发生,增加EN的摄入量.

Objective To explore the feasibility and guiding value of point-of-care ultrasound(PoCUS)in evaluating gastric residual volume(GRV)in the course of implementing enteral nutrition(EN)in patients with neurological critical illness.Methods Ninety patients with critical neurological diseases necessary for EN were admitted to the Department of Intensive Care Unit(ICU)of Taizhou Hospital of Integrated Traditional Chinese and Western Medicine from March 1,2017 to September 30,2018 were selected,and they were randomly divided into a GRV extraction group(control group)and a PoCUS GRV group(study group),45 patients in each group.Both groups were fed with Ruidai nutrient solution by nasogastric pump at a rate of 18 hours per day to persistently administer the target feeding volume for consecutive 7 days.The differences in tolerance of EN,the incidence of feeding interruption,the daily volume of EN fluid,the ratio of reaching total enteral nutrition(TEN)and the levels of serum albumin(Alb),prealbumin(PA)and prognosis were compared between the two groups.Results The incidences of reflux and wrong aspiration in the study group were significantly lower than those in the control group[8.9%(4/45)vs.24.4%(11/45)and 4.4%(2/45)vs.17.8%(8/45),both P<0.05].The EN liquid volume,ratio of reaching TEN,Alb and PA levels in the study group were significantly higher than those in the control group[EN liquid volume(mL/d):944.6±277.1 vs.783.7±230.5,the ratio of TEN:86.7%(39/45)vs.68.9%(31/45),Alb(g/L):30.6±3.0 vs.29.4±2.4,PA(g/L):280.5±31.8 vs.267.7±28.4,all P<0.05].The incidence of diarrhea[15.6%(7/45)vs.13.3%(6/45)],the incidence of feeding interruption[8.9%(4/45)vs.13.3%(6/45)],the length of stay in ICU(days:10.4±6.2 vs.8.3±5.4),the mortality[8.9%(4/45)vs.13.3%(6/45)]had no significant differences between the two groups(all P>0.05).Conclusion Evaluating GRV by PoCUS to adjust EN implementation plan can reduce the incidences of reflux and wrong aspiration and increase the EN intake.