床旁超声联合监测胃残余量和胃窦运动指数在危重症患者肠内营养中的应用研究

Application of bedside ultrasound monitoring gastric residual volume and motilite index in critical illness patients with enteral nutrition

目的:探讨床旁超声联合监测胃残余量(gastric residual volume,GRV)、胃窦运动指数(motilite index,MI)在危重症患者肠内营养支持治疗中的应用效果及可能作用机制,旨在为危重症患者肠内营养支持治疗指导提供参考。方法:选择2021年7月至2022年12月南通大学第二附属医院急诊ICU、急诊病区收治的需要肠内营养支持治疗的危重症患者100例为研究对象,采用随机数字表法分为研究组(50例)和对照组(50例)。对照组采用胃管回抽法监测GRV,根据GRV调整肠内营养支持治疗方案;研究组采用超声联合监测GRV和MI,根据GRV和MI调整肠内营养支持治疗方案。比较2组治疗前后血清炎性因子、体液免疫功能、细胞免疫功能、肠黏膜屏障功能、胃肠激素、营养学指标;统计2组预后相关指标、喂养相关并发症、感染相关并发症。结果:研究组患者治疗后血清C-反应蛋白、白细胞介素-6、肿瘤坏死因子-α明显低于同期对照组,白细胞介素-10明显高于同期对照组(P<0.05)。研究组患者治疗后免疫球蛋白A、免疫球蛋白G、免疫球蛋白M明显高于同期对照组(P<0.05)。研究组患者治疗后CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)明显高于同期对照组(P<0.05),CD8^(+)明显低于同期对照组(P<0.05)。研究组患者治疗后血清内毒素、D-乳酸、二胺氧化酶明显低于同期对照组(P<0.05)。研究组患者治疗后胃动素、5-羟色胺明显高于同期对照组(P<0.05),血管活性肽明显低于同期对照组(P<0.05)。研究组患者治疗后血清白蛋白、前白蛋白、转铁蛋白明显高于同期对照组(P<0.05)。研究组患者腹内压、达目标喂养时间、机械通气时间、ICU住院时间明显低于对照组(P<0.05)。研究组患者喂养相关并发症发生率为20.00%,明显低于对照组的68.00%(P<0.05)。研究组患者感染相关并发症发生率为12.00%,明显低于对照组的34.00%(P<0.01)。结论:床旁超声联合监测GRV和MI应用于危重症患者肠内营养支持治疗指导中,能够减少喂养及感染相关并发症的发生,促进患者康复。可能与拮抗炎症反应、改善免疫功能与肠黏膜屏障功能、调节胃肠激素与营养状态等因素有关。

Objective To study the effect and possible mechanism of bedside ultrasound monitoring gastric residual volume(GRV)and motilite index(MI)in enteral nutrition support therapy in critical illness patients,and provide reference for the guidance of enteral nutrition support therapy in critical illness patients.Methods A total of 100 critical illness patients requiring enteral nutrition support therapy from July 2021 to December 2022 were divided into study group(50 cases)and control group(50 cases).Patients in the control group monitored GRV by gastric tube extraction,and adjusted enteral nutrition support therapy scheme according to GRV.Patients in the study group monitored GRV and MI by ultrasound combined,and adjusted enteral nutrition support therapy scheme according to GRV and MI.Then the serum inflammatory factors,humoral immunity,cellular immunity,intestinal mucosal barrier function,gastrointestinal hormones and nutritional indexes were compared before and after treatment between two groups.The feeding-related complications and infection-related complications were analyzed.Results After treatment,the serum C-reactive protein,interleukin-6,and tumor necrosis factor-αin the study group were significantly lower than those in the control group during the same period,and the interleukin-10 was significantly higher than that in the control group(P<0.05).After treatment,the levels of immunoglobulin A,immunoglobulin G,and immunoglobulin M in the study group were significantly higher than those in the control group during the same period(P<0.05).After treatment,the CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)levels in the study group were significantly higher than those in the control group during the same period(P<0.05),and the CD8^(+)level was significantly lower than that in the control group(P<0.05).After treatment,the levels of serum endotoxin,D-lactate,and diamine oxidase in the study group were significantly lower than those in the control group(P<0.05).After treatment,the levels of motilin and serotonin in the study group were significantly higher than those in the control group(P<0.05),and the level of vasoactive peptides was significantly lower than that in the control group(P<0.05).After treatment,the serum albumin,prealbumin,and transferrin levels in the study group were significantly higher than those in the control group during the same period(P<0.05).The intra-abdominal pressure,target feeding time,mechanical ventilation time,and ICU hospitalization time in the study group were significantly lower than those in the control group(P<0.05).The incidence of feeding-related complications in the study group was 20.00%,which was significantly lower than 68.00%in the control group(P<0.05).The incidence of infection-related complications in the study group was 12.00%,which was significantly lower than 34.00%in the control group(P<0.01).Conclusion Bedside ultrasound monitoring GRV and MI can reduce the incidence of feeding-and infection-related complications,and promote recovery of patients.It may be related to antagonism of inflammatory reaction,improvement of immune function and intestinal barrier function,regulation of gastrointestinal hormones and nutritional status.