胃肠超声监测胃残余量在神经重症机械通气患者营养治疗中的应用

Application of gastrointestinal ultrasound to monitor gastric residual volume in nutritional treatment of patients with severe neurological mechanical ventilation

目的探讨胃肠超声监测胃残余量(GRV)在神经重症机械通气患者营养治疗中的应用价值。方法选择2021年1月至2022年12月于安徽省亳州市人民医院行机械通气的92例重症监护病房脑卒中合并呼吸衰竭患者,根据随机数字表法将其分为对照组和观察组,每组46例。对照组采用胃管回抽法监测GRV,根据GRV监测结果予以营养治疗,观察组予以胃肠超声监测GRV,根据GRV监测结果行营养治疗。观察两组反流、误吸、肠内营养不耐受发生情况,比较其喂养中断率、达目标喂养时间及营养指标变化。结果观察组反流率、肠内营养不耐受发生率、喂养中断率低于对照组,达目标喂养时间短于对照组,差异有统计学意义(P<0.05)。干预3 d后,两组血清前清蛋白、白蛋白水平均高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论胃肠超声监测GRV能够改善脑卒中合并呼吸衰竭机械通气患者肠内营养耐受性,降低喂养中断率,早期达到目标喂养量,改善患者营养状况。

Objective To investigate the application value of gastric residual volume(GRV)monitoring by gastrointestinal ultrasound in nutritional treatment of patients with severe neurological mechanical ventilation.Methods A total of 92 patients with stroke and respiratory failure in intensive care unit received mechanical ventilation in Bozhou People’s Hospital,Anhui Province from January 2021 to December 2022 were selected and divided into control group and observation group according to random number table method,with 46 cases in each group.GRV of the control group was monitored by gastric tube withdrawal method,and nutritional treatment was given according to GRV monitoring results;GRV of the observation group was monitored by gastrointestinal ultrasound,and nutritional treatment was given according to GRV monitoring results.The incidence of reflux,aspiration,and enteral nutritional intolerance in the two groups were observed,and the feeding interruption rate,feeding time,and nutritional indexes of the two groups were compared.Results The reflux rate,the incidence of enteral nutritional intolerance,and the rate of feeding interruption in the observation group were lower than those in the control group,and the time to reach the target feeding was shorter than that in the control group,the differences were statistically significant(P<0.05).After three days of intervention,serum prealbumin and albumin levels in two groups were higher than those before intervention,and those of observation group were higher than those of control group,the differences were statistically significant(P<0.05).Conclusion Gastrointestinal ultrasound monitoring of GRV can improve the enteral nutrition tolerance of patients with stroke complicated with mechanical ventilation of respiratory failure,reduce the rate of feeding interruption,achieve the target feeding amount early,and improve the nutritional status of patients.