超声监测胃残余量在急性创伤性完全性颈脊髓损伤患者肠内营养中的应用研究

Application of Ultrasonic Monitoring of Gastric Residual Volume in Enteral Nutrition in Patients with Acute Traumatic Complete Cervical Spinal Cord Injury

目的 探讨超声监测胃残余量在完全性颈脊髓损伤患者中的应用效果,以期帮助评价重症患者胃肠道功能并指导肠内营养(enteral nutrition, EN)实施。方法 2021年6月至2022年6月,采用便利抽样法选取上海市某三级甲等医院重症监护室(intensive care unit, ICU)收治的89例完全性颈脊髓损伤患者为研究对象,采用随机数字表法将其分为对照组(n=44)和观察组(n=45),分别采用常规方法和超声监测胃残余量,比较两组患者目标喂养达标时间、护士操作时间、营养相关指标水平及EN并发症发生率等。结果 观察组目标喂养达标时间为(60.14±5.39)h、护士测定胃残余量操作时间为(74.38±10.32)s,明显低于对照组的[(77.44±6.83)h、(94.82±8.42)s],差异均有统计学意义(均P<0.01)。EN 7 d后,两组患者营养相关指标均高于EN开始时,且观察组各指标水平均高于对照组,差异均有统计学意义(均P<0.05)。实施EN期间,观察组反流、误吸、腹胀发生率、营养液中断率均低于对照组,差异均有统计学意义(均P<0.05)。结论 超声监测胃残余量能更有效指导完全性颈脊髓损伤患者的EN实施,缩短目标喂养达标时间,降低相关并发症发生率,改善患者营养状态。

Objective To explore the application effect of ultrasonic monitoring of gastric residual volume in patients with complete cervical spinal cord injury,so as to help evaluate gastrointestinal function in severe patients and guide the implementation of enteral nutrition(EN).Methods From June 2021 to June 2022,89 patients with complete cervical spinal cord injury admitted to the intensive care unit(ICU)of a tertiary A hospital in Shanghai were selected by convenience sampling method as the research objects.The patients were divided into control group(n=44)and observation group(n=45)by random number table method.The gastric residual volume was monitored by conventional method and ultrasound monitor,respectively.The target feeding time,nurse operation time,level of nutrition-related indexes and incidence of enteral nutrition complications were compared between the two groups.Results The target feeding time of observation group was(60.14±5.39)h,and the operation time of nurses to measure gastric residual volume was(74.38±10.32)s,which was significantly lower than that of control group[(77.44±6.83)h,(94.82±8.42)s],and the differences were statistically significant(all P<0.01).After EN 7 days,nutrition-related indexes in 2 groups were higher than those at the beginning of EN,and the levels of indexes in observation group were higher than those in control group,with statistical significanc(all P<0.05).During EN implementation,the incidence of reflux,aspiration,abdominal distension and nutrient solution interruption in the observation group were lower than those in the control group,with statistical significance(all P<0.05).Conclusions Ultrasonic monitoring of gastric residual volume can guide the implementation of enteral nutrition in patients with complete cervical spinal cord injury more effectively,shorten the target feeding time,reduce the incidence of related complications,and improve the nutritional status of patients.