床旁超声监测胃残余量在慢性阻塞性肺疾病急性加重期有创机械通气患者肠内营养中的应用

Application of bedside ultrasound for monitoring gastric residual amount in volume nutrition in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨床旁超声监测胃残余量在慢性阻塞性肺疾病急性加重期(AECOPD)有创机械通气患者肠内营养(EN)的应用效果。方法选择71例AECOPD有创机械通气患者分为两组,超声组(n=43)和对照组(n=28)。超声组采用即时超声监测胃余量,对照组采用注射器抽吸法,两组均行有创机械通气,并经鼻胃管持续泵入肠内营养液治疗。比较两组患者脱机前和脱机试验2 h后pH值、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))的变化,以及EN期间72 h达标率、EN中断率和并发症(返流、误吸、腹泻、腹内压增高、消化道出血)发生率的差异。结果两组患者脱机前pH值、PaO_(2)、PaCO_(2)比较,差异均无统计学意义(t分别=1.10、0.80、0.46,P均>0.05),脱机试验2 h后,两组的pH值、PaO_(2)比较,差异均无统计学意义(t分别=1.10、0.51,P均>0.05),超声组PaCO_(2)小于对照组(t=17.30,P<0.05)。超声组患者的EN72 h达标率高于对照组,并发症发生率和EN中断率均低于对照组(χ^(2)分别=4.20、4.16、2.01,P均<0.05)。结论采用床边超声监测AECOPD有创机械通气患者胃残余量可以安全有效指导EN方案实施。

Objective To evaluate the effect of bedside ultrasound for monitoring gastric residual volume in enteral nutri-tion(EN)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)on invasive mechanical ventilation.Methods A total of 71 patients with AECOPD on invasive mechanical ventilation were randomized into two groups,ultrasound group(n=43)and control group(n=28).The ultrasound group applied the bedside ultrasound for monitor-ing gastric residual volume,the control group used syringes withdrawing.Both groups received invasive mechanical ventila-tion and continuous pumping of enteral nutrient solution through nasogastric tube.The pH value,arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2))before and 2h after weaning test,and the differences of 72h compliance rate of enteral nutrition,EN interruption rate and incidence of complications(regurgitation,aspiration,di-arrhea,increased intra-abdominal pressure and gastrointestinal bleeding)during EN were compared between two groups.Results There were no statistically significant differences in pH,PaO_(2) and PaCO_(2) between the ultrasound group and the control group before the weaning test(t=1.10,0.80,0.46,P>0.05).After weaning test 2 hours,there were no statistically sig-nificant differences in pH,PaO_(2) between the ultrasound group and the control group(t=1.10,0.51,P>0.05),PaCO_(2) was low-er in the ultrasound group(t=17.30,P<0.05),the 72h compliance rate of enteral nutrition in the ultrasound group was high-er than the control group,and the incidence of complications and EN interruption in ultrasound group were lower than the control group(χ^(2)=4.20,4.16,2.01,P<0.05).Conclusion Bedside ultrasound for monitoring gastric residual volume in patients with AECOPD invasive mechanical ventilation can safely and effectively guide the implementation of enteral nutri-tion program.