血浆瓜氨酸对重症患者肠内营养时机选择的价值研究

Study on value of plasma citrulline in timing selection of enteral nutrition in severe patients

目的 探讨针对重症患者实施血浆瓜氨酸水平测定对其肠内营养时机选择的价值。方法 本院于2018年9月至2020年9月纳入240例ICU重症患者开展研究。根据急性胃肠损伤(AGI)诊断标准观察患者AGI发生情况并开展AGI分级(其中AGIⅠ~Ⅳ级患者各60例),随后对所有患者进行血浆瓜氨酸水平测定,比较不同AGI分级患者一般资料、病情严重程度、预后情况及各阶段(入组时、肠内营养开始实施时、出现胃肠道相关并发症时)血浆瓜氨酸水平;再根据血浆瓜氨酸检测水平分组,其中浓度≥12μmol/L的137例患者纳入试验组,将血浆瓜氨酸浓度<12μmol/L的103例患者纳入对照组;探讨肠内营养时机的选择。结果 AGIⅣ级患者APACHEⅡ评分、SOFA评分及28 d病死率显著高于AGIⅠ、Ⅱ、Ⅲ级,其ICU治疗时间明显长于其他三级,而AGIⅣ级患者血浆瓜氨酸水平显著低于AGIⅠ、Ⅱ、Ⅲ级;试验组患者肠内营养24 h喂养量明显多于对照组,其喂养目标达标时间显著短于对照组;试验组喂养不耐受、胃潴留、腹泻及腹胀、胃肠道出血、腹腔高压等胃肠道相关并发症发生率及28 d病死率均低于对照组,差异有统计学意义(P<0.05)。结论 重症患者血浆瓜氨酸水平与其病情严重程度及AGI分级呈反比,通过测定血浆瓜氨酸含量可预测患者发生胃肠道并发症的风险,从而明确肠内营养开展时机(血浆瓜氨酸浓度≥12μmol/L)。

Objective To explore To explore the value of the determination of plasma citrulline level for the timing selection of enteral nutrition in severe patients.Methods From September 2018 to September 2020,240 severe patients from the ICU in our hospital were enrolled for this study.According to the diagnostic criteria of acute gastrointestinal injury(AGI),the occurrence of AGI in the patients was observed and the AGI classification was carried out(60 patients of AGIⅠ-Ⅳrespectively).Then,the plasma citrulline levels of all patients were determined.The general information,severity of the disease,prognosis,and plasma citrulline levels of patients with different AGI calssifications were compared,including at the time of enrollment,at the beginning of enteral nutrition,and at the occurence of gastrointestinal related complications.Then,137 patients with plasma citrulline concentration≥12μmol/L were included in the experimental group,and 103 patients with plasma citrulline concentration<12μmol/L were included in the control group.The selection of enteral nutrition time was explored.Results The APACHEⅡscore,SOFA score and 28 d mortality in gradeⅣAGI patients were significantly higher than those in gradeⅠ,ⅡandⅢAGI patients,and the duration of ICU treatment in gradeⅣAGI patients was significantly longer than that in other 3 grades of AGI patients,while the plasma citrulline level in grade 4 AGI patients was significantly lower than those in grade 1,2 and 3 AGI patients.The enteral nutrition 24 h feeding amount in the experimental group was significantly higher than that in the control group,and the feeding target reaching time was significantly shorter than that in the control group.The incidences of gastrointestinal complications such as feeding intolerance,gastric retention,diarrhea,abdominal distention,gastrointestinal bleeding,abdominal hypertension and other complications in the experimental group were lower than those in the control group,the difference was statistically significant(P<0.05).Conclusion The plasma citrulline level in severe patients is inversely proportional to the severity of the disease and the AGI grade.The risk of gastrointestinal complications can be predicted by measuring the plasma citrulline content,so as to determine the timing of enteral nutrition(plasma citrulline concentration≥12μmol/L).