腹内压对重症急性胰腺炎病人早期肠内营养喂养不耐受的预测价值

Predictive value of intra-abdominal pressure for feeding intolerance of early enteral nutrition in patients with severe acute pancreatitis

[目的]探讨腹内压(IAP)对重症急性胰腺炎(SAP)病人早期肠内营养(EEN)喂养不耐受(FI)的预测价值。[方法]回顾性分析2015年10月 2018年10月我院急诊科收治的120例SAP病人的临床资料,根据EEN耐受情况分为不耐受组(n=68)及 耐受组(n=52)。 比较两组病人EEN前基线IAP及EEN前3d平均IAP水平;绘制120例SAP病人基线IAP及EEN前3d平均IAP值的受试者工作特征(R OC)曲 线,分析其对EEN不耐受的预测效果。[结果]耐受组基线IAP及EEN前3d平均IAP水平低于不耐受组(P<0.001);基 线IAP与EEN前3d平均IAP预测病人喂养不耐受的ROC曲线下面积(A UC)分 别为0.83,0.82;灵敏度分别为82.3%、90.3%;特异度分别为70.7%,82.8%;预测喂养不耐受发生临界值分别为13mmHg、15mmHg。[结论]SAP病人EEN前基线IAP水平≥13mmHg及前3d平均IAP水平≥15mmHg时,对其喂养不耐受的发生有预测价值。

Objective:To explore the predictive value of intra-abdominal pressure(IAP)for feeding intolerance(FI)of early enteral nutrition(ENN)in patients with severe acute pancreatitis(SAP).Methods:Clinical data of 120 patients with SAP,who were admitted to emergency department of our hospital from October 2015 to October 2018,were collected and taken a retrospective analysis.According to tolerance of EEN,patients were divided into intolerance group(n=68 cases)and intolerance group(n=52 cases).Baseline IAP before early enteral nutrition(ENN)and average IAP of first 3 days of giving EEN were compared between two groups.Then receiver operating characteristic(ROC)curve of baseline IAP and average IAP during the first 3 days of EEN of 120 SAP patients were drawn to analyze the predictive effect on intolerance of EEN.Results:The baseline of IAP and the average IAP during the first 3 days of EEN of patients in tolerance group were lower than those of patients in intolerance group(P<0.001).The values of area under curre(AUC)of the baseline of IAP and the average IAP during the first 3 days of EEN to predict FI were 0.83 and 0.82 respevtively.The sensitivity were 82.3%and 90.3%in sequence.The specificity were 70.7%and 82.8%respectively.The thresholds of baseline IAP and average IAP to forecasting FI were 13 mmHg and 15 mmHg respectively.Conclusion:Baseline of IAP≥13 mmHg,and the average IAP during the first 3 days of EEN≥15 mmHg in patients with SAP,which have predictive value in occurrence of FI.