腹内压联合床旁超声监测胃残余量在有创机械通气患者早期肠内营养中的应用

Application of intra-abdominal pressure combined with point-of-care ultrasound to gastric residual volume monitoring in early enteral nutrition of patients undergoing invasive mechanical ventilation

目的探讨腹内压联合床旁超声监测胃残余量在有创机械通气患者早期肠内营养中的应用效果。方法选择120例行有创机械通气的危重患者作为研究对象,将其随机分为A组、B组、C组,各40例。3组均进行早期肠内营养治疗,其中A组采用腹内压监测胃残余量,B组采用床旁超声监测胃残余量,C组采用腹内压联合床旁超声监测胃残余量。比较3组机械通气时间、ICU住院时间、干预前后营养状况、肠内营养治疗依从性、并发症发生率。结果C组机械通气时间、ICU住院时间、调整肠内营养时间、肠内营养达标时间均短于A组、B组(均P<0.05);干预后,C组血清总蛋白、血清白蛋白、血清前白蛋白水平较干预前升高,且均高于A组、B组(均P<0.05);C组肠内营养治疗依从性高于A组、B组,总并发症发生率低于A组、B组(均P<0.05)。结论对有创机械通气并行肠内营养治疗的患者采用腹内压联合床旁超声监测胃残余量可改善其营养状况,缩短住院时间,提高肠内营养治疗依从性,降低肠内营养并发症发生率。

Objective To investigate the application effect of intra-abdominal pressure combined with point-of-care ultrasound to gastric residual volume monitoring in early enteral nutrition of patients undergoing invasive mechanical ventilation.Methods A total of 120 critically ill patients undergoing invasive mechanical ventilation were selected as the research subjects,and they were randomly divided into groups A,B,and C,with 40 cases in each group.The three groups received early enteral nutrition therapy,therein group A employed intra-abdominal pressure in monitoring gastric residual volume,group B employed point-of-care ultrasound in monitoring gastric residual volume,and group C employed intra-abdominal pressure combined with point-of-care ultrasound in monitoring gastric residual volume.The mechanical ventilation duration,length of ICU stay,pre-and post-intervention nutrition status,therapeutic compliance of enteral nutrition,and incidence rate of complications were compared between the three groups.Results Group C exhibited shorter mechanical ventilation duration,length of ICU stay,enteral nutrition adjustment time,and shorter time to reach standard of enteral nutrition as compared with groups A and B(all P<0.05).After intervention,group C interpreted higher levels of serum total protein,albumin,and prealbumin as compared with before treatment,and the aforesaid indices of group C were higher than those of groups A and B(all P<0.05);moreover,group C exhibited a higher therapeutic compliance of enteral nutrition,whereas a lower total incidence rate of complications as compared with groups A and B(all P<0.05).Conclusion Employing intra-abdominal pressure combined with point-of-care ultrasound in monitoring gastric residual volume in patients undergoing invasive mechanical ventilation and enteral nutrition therapy can ameliorate their nutrition status,shorten length of hospital stay,improve therapeutic compliance of enteral nutrition,and decrease the incidence rate of complications of enteral nutrition.