床旁胃肠超声指导ICU急性胃肠损伤危重病人肠内营养治疗的应用价值

The application value of bedside gastrointestinal ultrasound guidance for enteral nutrition therapy in critical patients with acute gastrointestinal injury in ICU

目的应用胃肠超声评价急性胃肠道损伤(AGI)病人的胃肠功能,并确定开始肠内营养(EN)治疗的时机。方法前瞻性选择2022年3月~2023年5月我院重症医学科(ICU)AGI水平为2级(AGIⅡ)的危重病人103例,记录了以下数据,包括超声胃窦横截面积(CSA)、降结肠或升结肠直径(CD)、蠕动频率(CPF)、EN开始时间、前白蛋白(PA)、EN剂量和EN并发症。经EN治疗后胃肠功能恢复判定为成功,如有EN治疗并发症,则判定失败。分析EN治疗后胃肠功能的变化,以确定EN时机。结果成功组68例,失败组35例。两组年龄、腹内压(IAP)、急性生理与慢性健康状况评分Ⅱ(APACHE-Ⅱ)、PA及疾病构成比较差异无统计学意义(P>0.05)。EN成功组的EN启动时间为(14.71±8.89)小时、CSA为(9.24±1.30)cm^(2),CD为(2.86±0.41)cm,EN失败组分别为(19.52±13.53)小时、(10.82±1.96)cm^(2)和(3.38±0.46)cm,两组比较差异有统计学意义(P<0.05),而前者的CPF[(2.84±0.96)次/分钟]较后者[(2.32±0.98)次/分钟]更快,差异有统计学意义(P<0.05)。ROC分析显示,CSA、CD和CPF预测EN成功具有较大的价值,阈值分别为CSA≤9 cm^(2)(AUC=0.892),CD≤2.8 cm(AUC=0.858)和CPF>3次/分钟(AUC=0.744);当CSA、CD和CPF联合预测生成PRE_1时,AUC最大(0.968),预测价值最高,可确定启动EN的最佳时机。结论超声监测CSA、CD、CPF可预测AGIⅡ级危重症病人EN治疗的疗效,并指导EN治疗的最佳启动时机。

Objective To apply gastrointestinal ultrasound to evaluate the gastrointestinal function of patients with acute gastrointestinal injury(AGI)and to determine the timing of starting enteral nutrition(EN)therapy to guide clinical enteral nutrition therapy.Methods One hundred and three critically ill patients with AGI level 2(AGIⅡ)were prospectively screened at the Department of Intensive Care Medicine(ICU)of the Second People’s Hospital of Anhui Province from March 2022 to May 2023,and the following data were recorded,including ultrasound gastric sinus cross-sectional area(CSA),diameter of the descending or ascending colon(CD),peristaltic frequency(CPF),time of EN initiation,prealbumin(PA),EN dose and EN complications.Recovery of gastrointestinal function after EN treatment was judged as successful,and failure was judged if there were complications of EN treatment.Changes in gastrointestinal function after EN treatment were analyzed to determine the timing of enteral nutrition.Results There were 68 cases in the successful group and 35 cases in the failed group.There were no statistically significant differences between the two groups in terms of age,intra-abdominal pressure(IAP),Acute Physiology and Chronic Health Status ScoreⅡ(APACHE-Ⅱ),PA,and disease composition(all P>0.05).The EN initiation time[(14.71±8.89)h],CSA[(9.24±1.30)cm^(2)]and CD[(2.86±0.41)cm]in the successful group were earlier or smaller than the failed group[(19.52±13.53)h,(10.82±1.96)cm^(2) and(3.38±0.46)cm](all P<0.05),whereas the CPF[(2.84±0.96)times/min]in the successful group was faster than thefailed group[(2.32±0.98)times/min](P<0.05).ROC analysis showed greater value for CSA,CD and CPF to predict EN success,with thresholds of CSA≤9 cm^(2)(AUC=0.892),CD≤2.8 cm(AUC=0.858)and CPF>3 times/min(AUC=0.744);when the combination of CSA,CD and CPF was predicted to generate PRE_1,the AUC was the largest(0.968)and had the highest predictive value,which could determine the best time to initiate EN.Conclusion Ultrasound monitoring of the cross-sectional area of the gastric sinus,the internal diameter of the colon,and the frequency of colonic peristalsis can predict the efficacy of enteral nutrition therapy in critically ill patients with gradeⅡacute gastrointestinal injury and guide the optimal timing of initiating enteral nutrition therapy.