动态监测胃残余量在治疗ICU有创机械通气鼻饲患者中对呼吸机相关性肺炎的预防效果

Preventive effect of dynamic monitoring of gastric residual volume on ventilator-associated pneumonia in the treatment of ICU patients with invasive mechanical ventilation and nasal feeding

目的研究动态监测胃残余量在治疗ICU有创机械通气鼻饲患者中对呼吸机相关性肺炎的预防效果。方法选取2017年9月~2019年3月间我院收治的机械通气时间超过48h、进行肠内营养>2d的重症患者90例为研究对象,按照床号分组,单号为对照组(n=45),双号为观察组(n=45),对照组采用普通控制胃残余量方法监测,观察组采用动态监测胃残余量方法强化控制,密切观察两组患者的胃内容物反流、误吸情况。比较两组患者的呼吸机相关性肺炎的发生率、病死率及胃内容物反流发生情况,同时比较机械通气时间及入住ICU时间和治疗前后的血气分析。结果观察组患者VAP的发病率和病死率及胃内容物反流、误吸的发生率均明显低于对照组(P<0.05),机械通气时间、入住ICU时间等康复进程时间均明显短于对照组(P<0.01);治疗后,观察组的pH值改善情况明显优于对照组,PaO2明显高于对照组(P<0.01),而PaCO2比较差异无统计学意义(P>0.05)。结论动态监测胃残余量预防ICU有创机械通气鼻饲患者发生呼吸机相关性肺炎的效果显著,可明显降低患者的呼吸机相关性肺炎发病率和病死率,缩短机械通气,加速恢复,改善血气分析情况,值得在临床上推广。

Objective To study the preventive effect of dynamic monitoring of gastric residual volume on ventilator-associated pneumonia in the treatment of ICU patients with invasive mechanical ventilation and nasal feeding.Methods 90 critically ill patients with mechanical ventilation time exceeding 48h and enteral nutrition>2d admitted and treated at our hospital from September 2017 to March 2019 were selected as the study objects,and divided into groups according to the bed number,with single number as the control group(n=45)and double number as the observation group(n=45).The control group was monitored by normal method for controlling the gastric residual volume,while the observation group was intensively controlled by dynamic method for monitoring the gastric residual volume.The reflux and aspiration of gastric contents in the two groups of patients were closely observed.The incidence and mortality of ventilator-associated pneumonia as well as the reflux of gastric contents were compared between the two groups of patients,and the mechanical ventilation time,ICU stay time,and blood gas analysis before and after treatment were compared.Results The incidence and mortality of VAP as well as the incidence of reflux and aspiration of gastric contents of patients in the observation group were all significantly lower than those in the control group(P<0.05),and the mechanical ventilation time,ICU stay time and other rehabilitation process time were all significantly lower than those in the control group(P<0.01);After treatment,the improvement of pH value in the observation group was significantly better than that in the control group,and PaO2 was significantly higher than that in the control group(P<0.01),while the difference in PaCO2 was not statistically significant(P>0.05).Conclusion Dynamic monitoring of gastric residual volume has a significant effect in preventing ventilator-associated pneumonia in ICU patients with invasive mechanical ventilation and nasal feeding,which can significantly reduce the incidence and mortality of ventilator-associated pneumonia in patients,shorten mechanical ventilation,accelerate recovery,and improve blood gas analysis,which is worthy of clinical promotion.