腹内压监测在ICU患者早期肠内营养中应用研究

The application of intra-abdominal pressure monitoring in early enteral nutrition of intensive care unit patients

目的探讨腹内压监测在指导ICU患者实施早期肠内营养治疗中的应用效果。方法选取自2015年7月至2017年7月衡水市人民医院重症医学科收治的可实施早期肠内营养治疗的患者203例,采用随机数字表法分为A组(n=105)与B组(n=98)。其中,A组通过监测胃残余量给予早期肠内营养治疗,B组通过腹内压监测给予早期肠内营养治疗。比较两组患者早期肠内营养不耐受的发生率、72 h内达到预计能量80%患者比例、机械通气时间、ICU住院时间、呼吸机相关性肺炎发生率、多脏器功能障碍综合征发生率及住院期间病死率。结果B组患者腹胀、腹泻、呕吐,以及出现2种及以上症状的发生率均低于A组,差异有统计学意义(P<0.05)。B组66.3%(65/98)的患者在72 h内达到预计能量80%目标,显著高于A组的37.1%(39/105),组间比较,差异有统计学意义(P<0.05)。B组患者机械通气时间、ICU住院时间、呼吸机相关性肺炎发生率及多脏器功能障碍综合征发生率均低于A组,差异有统计学意义(P<0.05)。两组患者住院期间病死率比较,差异无统计学意义(P>0.05)。结论相较于胃残余量监测,腹内压监测在指导ICU患者早期肠内营养治疗中有明显优势,有助于改善患者预后。

Objective To investigate the effect of intra-abdominsl pressure(IAP)monitor technology on early enteral nutrition(EEN)in intensive care unit(ICU)patients.Methods A prospective study was performed on 203 cases of patients with early enteral nutrition who were admitted to the intensive care unit from July 2015 to July 2017.Patients were randomly divided into the Group A(n=105)and Group B(n=98).Group A of patients received early enteral nutrition therapy by monitoring gastric residual volume,and Group B of patients received early enteral nutrition therapy by monitoring abdominal pressure.The incidence of early enteral nutritional intolerance,the proportion of patients reaching 80%of expected energy within 72 hours,the duration of mechanical ventilation,the length of ICU stay,the incidence of ventilator-associated pneumonia,the incidence of multi-organ dysfunction syndrome(MODS)and the mortality during hospitalization were compared between the two groups.Results The incidence of abdominal distension,diarrhea,vomiting and the occurrence of two or more symptoms in Group B was lower than that in Group A,with statistically significant differences(P<0.05).In Group B,66.3%(65/98)of patients achieved 80%of the expected energy within 72 hours,which was significantly higher than 37.1%(39/105)of Group A,and the difference was statistically significant(P<0.05).The duration of mechanical ventilation,length of stay in ICU,incidence of ventilator-associated pneumonia and incidence of MODS in Group B were all lower than those in Group A(P<0.05).There was no statistically significant difference in mortality between the two groups(P>0.05).Conclusion Compared with gastric residue volume,intra-abdominal pressure has obvious advantages in guiding ICU patients to carry out early enteral nutrition treatment,and has a positive effect on improving the prognosis of patients.