Intra-abdominal pressure monitoring in predicting outcome of patients with severe acute pancreatitis

BACKGROUND: Severe acute pancreatitis (SAP) is a serious disease with many complications, high mortality and poor prognosis. It is characterized by rapid deterioration and poses one of the most difficult challenges in clinical practice. Previous investigations suggest that SAP is one of the main causes of intra-abdominal pressure (IAP) increase. The aim of this study was to evaluate the utility of IAP-monitoring in predicting the severity and prognosis of SAP. METHODS: Eighty-nine patients with SAP who had been treated from February 2001 to December 2005 were studied. Since bladder pressure accurately reflects IAP, we measured it instead of IAP. Bladder pressure was measured at the time of admission and every 12 hours in the course of the disease, 9 consecutive times in all. The APACHE II scores of all patients were obtained within 24 hours after admission. According to a maximum bladder pressure <10 cmH(2)O, all patients were divided into two groups, mildly-elevated and severely-elevated. Mortality and mean APACHE II scores in the two groups were calculated. In addition, the mean bladder pressure and APACHE II scores in survivors were compared with those in deaths. RESULTS: Sixty-eight of the 89 patients were in the severely-elevated group. Mortality and mean APACHE II scores in this group were much higher than those in the mildly-elevated group (mortality, 39.71% vs. 9.52%; mean APACHE II score, 23.15 +/- 7.42 vs. 15.95 +/- 5.35, P<0.01). The mean bladder pressures and APACHE II scores in deaths were significantly greater than those in survivors (mean bladder pressure, 14.1 +/- 3.8 vs. 9.2 +/- 2.3 cmH(2)O, P<0.01; mean APACHE II score, 27.83 +/- 4.87 vs. 18.37 +/- 6.74, P<0.01). CONCLUSION: It is suggested that IAP may be used as a marker of the severity and prognosis of SAP.

Effect of intra-abdominal pressure on respiratory function in patients undergoing ventral hernia repair

AIM: To determine the influence of intra-abdominal pressure(IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period. METHODS: Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study.IAP monitoring was performed via both a balloontipped nasogastric probe [intragastric pressure(IGP), Ci MON, Pulsion Medical Systems, Munich, Germany] and a urinary catheter [intrabladder pressure(IBP), Uno Meter Abdo-Pressure Kit, Uno Medical, Denmark] on five consecutive stages:(1) after tracheal intubation(AI);(2) after ventral hernia repair;(3) at the end of surgery;(4) during spontaneous breathing trial through the endotracheal tube; and(5) at 1 h after tracheal extubation. The patients were in the complete supine position during all study stages.RESULTS: The IAP(measured via both techniques) increased on average by 12% during surgery compared to AI(P < 0.02) and by 43% during spontaneous breathing through the endotracheal tube(P < 0.01). In parallel, the gradient between РаСО2 and Et CO2 [Р(а-et)CO2] rose significantly, reaching a maximum during the spontaneous breathing trial. The PаO2/Fi O2 decreased by 30% one hour after tracheal extubation(P = 0.02). The dynamic compliance of respiratory system reduced intraoperatively by 15%-20%(P < 0.025). At all stages, we observed a significant correlation between IGP and IBP(r = 0.65-0.81, P < 0.01) with a mean bias varying from-0.19 mm Hg(2SD 7.25 mm Hg) to-1.06 mm Hg(2SD 8.04 mm Hg) depending on the study stage. Taking all paired measurements together(n = 133), the median IGP was 8.0(5.5-11.0) mm Hg and the median IBP was 8.8(5.8-13.1) mm Hg. The overall r2 value( n = 30) was 0.76(P < 0.0001). Bland and Altman analysis showed an overall bias for the mean values per patient of 0.6 mm Hg(2SD 4.2 mm Hg) with percentage error of 45.6%. Looking at changes in IAP between the different study stages, we found an excellent concordance coefficient of 94.9% comparing IBP and IGP( n = 117).CONCLUSION: During ventral hernia repair, the IAP rise is accompanied by changes in Р(а-et)CO2 and PаO2/Fi O2-ratio. Estimation of IAP via IGP or IBP demonstrated excellent concordance.

Noninvasive monitoring of intra-abdominal pressure by measuring abdominal wall tension

BACKGROUND: Noninvasive monitoring of intra-abdominal pressure(IAP) by measuring abdominal wall tension(AWT) was effective and feasible in previous postmortem and animal studies. This study aimed to investigate the feasibility of the AWT method for noninvasively monitoring IAP in the intensive care unit(ICU).METHODS: In this prospective study, we observed patients with detained urethral catheters in the ICU of Shanghai Tenth People's Hospital between April 2011 and March 2013. The correlation between AWT and urinary bladder pressure(UBP) was analyzed by linear regression analysis. The effects of respiratory and body position on AWT were evaluated using the paired samples t test, whereas the effects of gender and body mass index(BMI) on baseline AWT(IAP<12 mm Hg) were assessed using one-way analysis of variance.RESULTS: A total of 51 patients were studied. A significant linear correlation was observed between AWT and UBP(R=0.986, P<0.01); the regression equation was Y=–1.369+9.57X(P<0.01). There were signif icant differences among the different respiratory phases and body positions(P<0.01). However, gender and BMI had no signif icant effects on baseline AWT(P=0.457 and 0.313, respectively).CONCLUSIONS: There was a signif icant linear correlation between AWT and UBP and respiratory phase, whereas body position had signif icant effects on AWT but gender and BMI did not. Therefore, AWT could serve as a simple, rapid, accurate, and important method to monitor IAP in critically ill patients.

The effect of increased intra-abdominal pressure on orbital subarachnoid space width and intraocular pressure

In accordance with the trans-lamina cribrosa pressure difference theory, decreasing the trans-lamina cribrosa pressure difference can re- lieve glaucomatous optic neuropathy. Increased intracranial pressure can also reduce optic nerve damage in glaucoma patients, and a safe, effective and noninvasive way to achieve this is by increasing the intra-abdominal pressure. The purpose of this study was to observe the changes in orbital subarachnoid space width and intraocular pressure at elevated intra-abdominal pressure. An inflatable abdominal belt was tied to each of 15 healthy volunteers, aged 22-30 years （12 females and 3 males）, at the navel level, without applying pressure to the abdomen, before they laid in the magnetic resonance imaging machine. The baseline orbital subarachnoid space width around the optic nerve was measured by magnetic resonance imaging at 1, 3, 9, and 15 mm behind the globe. The abdominal belt was inflated to increase the pressure to 40 mmHg （1 mmHg = 0.133 kPa）, then the orbital subarachnoid space width was measured every 10 minutes for 2 hours. After removal of the pressure, the measurement was repeated 10 and 20 minutes later. In a separate trial, the intraocular pressure was measured for all the subjects at the same time points, before, during and after elevated intra-abdominal pressure. Results showed that the baseline mean orbital subarachnoid space width was 0.88 ＋ 0.1 mm （range： 0.77-1.05 mm）, 0.77 ＋ 0.11 mm （range： 0.60-0.94 mm）, 0.70 ＋ 0.08 mm （range： 0.62-0.80 ram）, and 0.68 _＋ 0.08 mm （range： 0.57-0.77 mm） at 1, 3, 9, and 15 mm behind the globe, respectively. During the elevated intra-abdominal pressure, the orbital subarachnoid space width increased from the baseline and dilation of the optic nerve sheath was significant at 1, 3 and 9 mm behind the globe. After decompression of the abdominal pressure, the orbital subarachnoid space width normalized and returned to the baseline value. There was no significant difference in the intraocular pressure before, during and after the intra-abdominal pressure elevation. These results verified that the increased intra-abdominal pressure widens the orbital subarachnoid space in this acute trial, but does not alter the intraocular pressure, indicating that intraocular pressure is not affected by rapid increased in- tra-abdominal pressure. This study was registered in the Chinese Clinical Trial Registry （registration number： ChiCTR-ONRC-14004947）.

Study of intra-abdominal hypertension prevalence and awareness level among experienced ICU medical staff

Background:Intra-abdominal hypertension(IAH) is a disease with high morbidity and mortality among critically ill patients.The study's objectives were to explore the prevalence of IAH and physicians' awareness of the 2013 World Society of Abdominal Compartment Syndrome(WSACS) guidelines in Chinese intensive care units(ICUs).Methods:A cross-sectional study of four ICUs in Southwestern China was conducted from June 17 to August 2,2014.Adult patients admitted to the ICU for more than 24 h,with bladder catheter but without obvious intravesical pressure(IVP) measurement contraindications,were recruited.Intensivists with more than 5 years of ICU working experience were also recruited.Epidemiological information,potential IAH risk factors,IVP measurements and questionnaire results were recorded.Results:Forty-one patients were selected.Fifteen(36.59%) had IVP?12mm Hg.SOFA(Sequential Organ Failure Assessment) hepatic and neurological sub-scores were utilized as independent predictors for IAH via logistic backward analysis.Thirty-seven intensivists participated in the survey(response rate:80.43%).The average score of each center was less than 35 points.All physicians believed the IAH prevalence in their departments was no more than 20.00%.A significant negative correlation was observed between the intensivists' awareness of the 2013 WSACS guidelines and the IAH prevalence in each center(r=-0.975,P=0.025).Conclusion:The prevalence and independent predictors of IAH among the surveyed population are similar to the reports in the literature.Intensivists generally have a low awareness of the 2013 WSACS guidelines.A systematic guideline training program is vital for improving the efficiency of the diagnosis and treatment of IAH.

Mild to moderate intra-abdominal hypertension: Does it matter?

This review summarizes the epidemiology, pathophysiological consequences and impact on outcome of mild to moderate(Grade Ⅰ to Ⅱ) intra-abdominal hypertension(IAH), points out possible pitfalls in available treatment recommendations and focuses on tasks for future research in the field. IAH occurs in about 40% of ICU patients. Whereas the prevalence of abdominal compartment syndrome seems to be decreasing, the prevalence of IAH does not. More than half of IAH patients present with IAH grade Ⅰ and approximately a quarter with IAH grade Ⅱ. However, most of the studies have addressed IAH as a yes-or-no variable, with little or no attention to different severity grades. Even mild IAH can have a negative impact on tissue perfusion and microcirculation and be associated with an increased length of stay and duration of mechanical ventilation. However, the impact of IAH and its different grades on mortality is controversial. The influence of intra-abdominal pressure(IAP) on outcome most likely depends on patient and disease characteristics and the concomitant macro- and microcirculation. Therefore, management might differ significantly. Today, clear triggers for interventions in different patient groups with mild to moderate IAH are not defined. Further studies are needed to clarify the clinical importance of mild to moderate IAH identifying clear triggers for interventions to lower the IAP.

基于“-TT”结构经监护仪腹内压监测法降低重症患者喂养不耐受发生率的研究

探究基于“-TT”结构经监护仪腹内压监测法降低重症患者喂养不耐受发生率的效果。选取2022年8月—2023年8月四川省自贡市第四人民医院抢救监护室(emergency intensive care unit,EICU)60例重症需行肠内营养(enteral nutrition,EN)支持的患者作为研究对象,采用随机数字表法将患者分为参照组和试验组,每组各30例。参照组实施常规EN管理,试验组在参照组基础上实施基于“-TT”结构经监护仪腹内压监测法,对比两组患者的喂养不耐受发生率。结果显示,与参照组相比,试验组喂养不耐受发生率较低(P<0.05);试验组达到目标喂养量时间较短(P<0.05);试验组EICU停留时间较短(P<0.05)。研究发现,于EICU重症需行EN支持患者的管理中,基于“-TT”结构经监护仪腹内压监测法具有一定的临床应用价值,通过对患者腹压变化的实时监测,可以及时调整喂养方案,降低其喂养不耐受发生率,缩短患者达到目标喂养量的时间,改善患者预后,值得借鉴。

Abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension

Background Intra-abdominal hypertension （IAH） is common in acute respiratory distress syndrome （ARDS） patients and when resulting in decrease of chest wall compliance will weaken the effect of positive end expiratory pressure （PEEP）. We investigated the effect of PEEP titrated by transpulmonary pressure （Ptp） on oxygenation and respiratory mechanics in ARDS patients with IAH compared with PEEP titrated by ARDSnet protocol. Methods ARDS patients admitted to the intensive care unit （ICU） of the Zhongda Hospital were enrolled. Patients were ventilated with volume control mode with tidal volume of 6 ml/kg under two different PEEP levels titrated by Ptp method and ARDSnet protocol. Respiratory mechanics, gas exchange and haemodynamics were measured after 30 minutes of ventilation in each round. IAH was defined as intra-abdominal pressure of 12 mmHg or more, Results Seven ARDS patients with IAH and 8 ARDS patients without IAH were enrolled. PEEP titrated by Ptp were significant higher than PEEP titrated by ARDSnet protocol in both ARDS patients with IAH （（17.3±2.6）cmH20 vs. （6.3±1.6） cmH2O and without IAH （（9.5±2.1） cmH2O vs. （7.8±1.9） cmH2O）. Arterial pressure of O2/fraction of inspired oxygen （PaO2/ FiO2） was much higher under PEEP titrated by Ptp when compared with PEEP titrated by ARDSnet protocol in ARDS patients with IAH （（27.2±4.0） cmHg vs. （20.9± 5.0） cmHg. But no significant difference of PaO2/FiO2 between the two methods was found in ARDS patients without IAH. In ARDS patients with IAH, static compliance of lung and respiratory system were higher under PEEP titrated by Ptp than by ARDSnet protocol. In ARDS patients with IAH, central venous pressure （CVP） was higher during PEEP titrated by Ptp than by ARDSnet protocol. Conclusion Positive end expiratory pressure titrated by transpulmonary pressure was higher than PEEP titrated by ARDSnet protocol and improved oxygenation and respiratory mechanics in ARDS patients with IAH.

Effects of Altered Intra-abdominal Pressure on the Upper Airway Collapsibility in a Porcine Model

Background： Obstructive sleep apnea is strongly associated with obesity, particularly abdominal obesity common in centrally obese males. Previous studies have demonstrated that intra-abdominal pressure （IAP） is increased in morbid obesity, and tracheal traction forces may influence pharyngeal airway collapsibility. This study aimed to investigate that whether IAP plays a role in the mechanism of upper airway （UA） collapsibility via IAP-related caudal tracheal traction. Methods： An abdominal wall lifting （AWL） system and graded CO2 pneumoperitoneum pressure was applied to four supine, anesthetized Guizhou miniature pigs and its effects on tracheal displacement （TD） and airflow dynamics of UA were studied. Individual run data in 3 min obtained before and after AWL and obtained before and after graded pneumoperitoneum pressure were analyzed. Differences between baseline and AWL/graded pneumoperitoneum pressure data of each pig were examined using a Student＇s t-test or analysis of variance. Results： Application of AWL resulted in decreased IAP and significant caudal TD. The average displacement amplitude was 0.44 mm （P 〈 0.001 ）. There were three subjects showed increased tidal volume （TV） （P 〈 0.01 ） and peak inspiratory airflow （P 〈 0.01 ）; however, the change of flow limitation inspiratory UA resistance （Rua） was not significant. Experimental increased lAP by pneumoperitoneum resulted in significant cranial TD. The average displacement amplitude was 1.07 mm （P 〈 0.001） when lAP was 25 cmH2O compared to baseline. There were three subjects showed reduced Rua while the TV increased （P 〈 0.01 ）. There was one subject had decreased TV and elevated Rua （P 〈 0.001）. Conclusions： Decreased IAP significantly increased caudal TD, and elevated lAP significantly increased cranial TD. However, the mechanism of UA collapsibility appears primarily mediated by changes in lung volume rather than tracheal traction effect. TV plays an independent role in the mechanism of UA collapsibility.

成人ICU患者显性误吸影响因素分析

目的探讨成人ICU患者发生显性误吸的影响因素,为识别高危人群、降低显性误吸发生率提供参考。方法选取成人ICU患者798例,利用单因素分析和logistic回归分析探讨显性误吸的影响因素。结果成人ICU患者显性误吸发生率为16.9%,机械通气、胃残余量、腹腔内压力、误吸史、呕吐是危险因素(均P<0.05)。结论成人ICU患者有发生显性误吸的风险,需重点关注机械通气、有误吸史及呕吐的患者,减少胃残余量和降低腹腔内压力,以减少显性误吸。

脓毒症休克患者腹内压和下腔静脉呼吸变异度对预测患者容量反应性的价值研究

目的:探究脓毒症休克患者腹内压、下腔静脉呼吸变异度(IVC-RVI)对预测患者容量反应性的价值研究。方法:选择86例脓毒症休克患者为研究对象,根据液体复苏后容量反应性情况分为无反应组(n=59)和反应组(n=27)。监测患者液体复苏前及复苏后6 h腹内压、IVC-RVI,分析其对容量反应性的影响。结果:两组患者的年龄、性别、合并基础疾病、感染部位、急性生理学与慢性健康状况评分Ⅱ(APACHEII)、收缩压(SBP)及心率(HR)均无统计学差异(P>0.05);两组患者复苏前腹内压比较,差异无统计学意义(P>0.05);液体复苏后6 h,两组患者腹内压均升高,且无反应组腹内压及复苏前后腹内压差值均高于反应组(P<0.05)。无反应组IVC-RVI低于反应组(P<0.05)。Logistic回归分析显示,IVC-RVI、复苏后6 h腹内压为脓毒症休克患者容量反应性的独立影响因素(P<0.05)。受试者工作特征曲线分析显示,复苏后6 h腹内压、IVC-RVI预测脓毒症休克患者无容量反应性的截断值分别为9.860 mmHg、16.95%,敏感度分别为78.00%、50.00%,特异度分别为82.00%、50.00%,曲线下面积(AUC)分别为0.782、0.722(P<0.05)。两个指标联合预测的价值最高(P<0.05),AUC为0.817(95%CI:0.725~0.909),敏感度、特异度分别为84.00%、78.00%。结论:腹内压偏高、IVC-RVI偏低是导致脓毒症休克患者液体复苏后无容量反应性的影响因素,临床治疗中可据此合理制定液体复苏方案,以提高治疗效果,降低并发症风险。

持续腹内压监测联合前馈控制理论在机械通气患者早期肠内营养耐受性评估中的临床应用

目的 通过随机试验设计,探究持续腹内压监测联合前馈控制理论在提升机械通气患者早期肠内营养耐受性方面的效果。方法 本研究共纳入2022年6月至2023年6月在三明市第二医院就诊的机械通气患者100例,将机械通气患者随机分为两组,每组各50例,对照组采用常规肠内营养支持,试验组则在此基础上引入持续腹内压监测与前馈控制理论。观察两组患者的机械通气时间与住院时间、干预后第1、3、7、14天的腹内压变化情况、营养状态指标、营养风险筛查2002(NRS2002)评分以及肠内营养的耐受性情况。结果 试验组机械通气时间和住院时间均显著短于对照组,差异有统计学意义(P <0.05)。干预后第7、14天,试验组腹内压显著低于对照组,差异有统计学意义(P <0.05)。干预后第14天,试验组血清前白蛋白、血清白蛋白以及血红蛋白水平均显著高于对照组,差异有统计学意义(P <0.05)。干预后第14天,试验组NRS2002评分显著低于对照组,差异有统计学意义(P <0.05)。试验组良好耐受比例显著高于对照组,而中等耐受和不耐受比例均显著低于对照组,差异有统计学意义(P <0.05)。结论 结合持续的腹内压监测和前馈控制理论,可以显著提高机械通气患者在早期对肠内营养的耐受性,优化患者营养状态并减少营养缺乏的风险,这种方法在临床实践中具有广泛的应用价值。

气管插管后早期胃肠减压对机械通气患者呼吸力学的影响

目的探讨气管插管后早期进行胃肠减压对机械通气患者呼吸力学的影响及其临床应用价值。方法本研究为前瞻性观察性研究,将新疆医科大学第一附属医院急诊抢救室2023年3月至2023年6月接受气管插管后机械通气的132例患者分为观察组(n=66)和对照组(n=66)。观察组在气管插管后的1 h内进行胃肠减压,对照组在气管插管后的6 h内未进行胃肠减压治疗。收集两组患者的一般资料,并在气管插管即刻(T0)、机械通气1 h(T1)、机械通气2 h(T2)、机械通气4 h(T3)、机械通气6 h(T4)时分别测量两组患者的呼吸力学参数、氧合及腹内压变化情况进行并分析。结果在T0时,两组的呼吸力学指标差异均无统计学意义(P>0.05),两组的气道峰压(Ppeak)均下降差异无统计学意义(P>0.05);在T3和T4时,观察组的平台压(Pplat)和平均气道压(Pmean)显著低于对照组,静态顺应性(Cstat)显著高于对照组,差异均有统计学意义(P<0.05);在T1后,观察组的PaO 2/FiO 2显著高于对照组(P<0.05);在T4时,观察组的腹内压显著低于对照组(P<0.05)。结论在气管插管后1 h内进行胃肠减压能够有效改善机械通气患者的呼吸力学指标,降低腹内压,提高肺部顺应性和氧合情况。

首次早期肠内营养患者发生ICU获得性衰弱的影响因素研究

目的探讨首次早期肠内营养的患者发生ICU获得性衰弱(ICU-AW)的影响因素。方法对2021年1月至2022年12月期间在河南省人民医院急诊重症监护病房(EICU)进行首次早期肠内营养治疗的212例危重患者进行回顾性研究,根据早期肠内营养治疗期间是否发生ICU-AW分为ICU-AW组(n=76例)和非ICU-AW组(n=136例),记录两组患者的一般资料、早期肠内营养启动时间、热量-蛋白供应量及肠内营养第7天时腹内压值,分析腹内压和ICU-AW的关系,同时探讨发生ICU-AW的影响因素。结果两组患者在年龄、机械通气、急性生理与慢性健康(APACHEⅡ)评分、血糖、进行肾脏替代治疗、使用皮质类固醇药物、平均每日热卡量、平均每日蛋白量、肠内营养不耐受、肠内营养治疗第7天时腹内压等方面,差异有统计学意义(P<0.05);其中ICU-AW组患者肠内营养第7天时的腹内压为(16.42±1.52)cmH2O均为高于非ICU-AW组(12.88±2.19)cmH2O,差异有统计学意义(P<0.05);logistic回归分析显示:发生ICU-AW的影响因素为年龄大、APACHEⅡ评分高、机械通气、使用皮质类固醇药物、平均每日热卡量及蛋白量低、发生肠内营养不耐受、肠内营养治疗第7天时腹内压高。结论年龄大、APACHEⅡ评分高、机械通气、使用皮质类固醇药物、平均每日热卡量及蛋白量低、平均每日热卡量及蛋白量低、发生肠内营养不耐受、肠内营养治疗第7天时腹内压高是首次早期肠内营养治疗患者发生ICU-AW的危险因素,应给予有针对性的早期干预。

基于腹内压分级肠内营养护理方案的构建及应用

目的构建基于腹内压分级的肠内营养护理方案,评价临床应用效果。方法将2023年4-11月重症监护室住院的80例伴腹内高压重症患者按时间段分为两组各40例。对照组采用常规肠内营养护理;观察组采用基于腹内压分级的肠内营养护理方案。连续实施7 d后评价效果。结果观察组与对照组分别有37例、38例完成研究。观察组喂养不耐受发生率显著低于对照组,干预7 d后总蛋白、白蛋白、前白蛋白、血红蛋白水平显著高于对照组,达预期目标喂养量时间显著短于对照组(均P<0.05)。结论对ICU腹内高压重症患者实施基于腹内压分级的肠内营养护理方案,可降低喂养不耐受发生率,提高喂养有效率,改善患者营养状况。

重症急性胰腺炎行肠内营养病人动态腹内压监测预警分级标准及干预方案的构建

目的:构建重症急性胰腺炎(SAP)行肠内营养病人动态腹内压监测预警分级标准及干预方案。方法:检索国内外文献,拟定SAP行肠内营养病人动态腹内压监测预警分级标准及干预方案初稿。采用德尔菲专家函询法对专家进行2轮函询,形成SAP行肠内营养病人动态腹内压监测预警分级标准及干预方案。结果:2轮专家函询的问卷回收率均为100%,专家权威系数均为0.918,变异系数分别为0.077~0.156和0.056~0.167,肯德尔协调系数分别为0.353和0.331(P<0.001)。最终形成包含3项一级指标、13项二级指标、26项三级指标的SAP行肠内营养病人动态腹内压监测预警分级标准及干预方案。结论:本研究构建的SAP行肠内营养病人动态腹内压监测预警分级标准及干预方案具有一定的科学性和实用性,有利于指导临床实践。

肠内营养采用腹内压联合24h胃残余量监测调适方案在呼吸科ICU鼻饲患者中的作用评估

背景如何保证呼吸科重症监护室(intensive care unit,ICU)患者肠内营养治疗安全性及有效性成为研究热点.胃残余量为肠内营养重要评估指标,可指导后续干预但近年来临床对胃残余量的评估准确性、科学性存在一定争议.目的探讨腹内压联合24 h胃残余量监测调适的肠内营养方案在呼吸科ICU鼻饲患者中的应用效果.方法选取2019-02/2020-12我院呼吸科ICU鼻饲患者82例,依据随机数字表法分为研究组(n=41)及对照组(n=41).对照组采取常规营养支持,研究组采取腹内压联合24 h胃残余量监测调适的肠内营养方案干预.统计两组治疗情况、干预前后营养状态指标[转铁蛋白(transferrin,TF)、前白蛋白(prealbumin,PA)、白蛋白(albumin,ALB)]水平、T细胞亚群指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平、不良事件发生情况.结果(1)研究组达目标喂养用时、ICU住院时间短于对照组(P<0.05);(2)干预后两组TF、PA、ALB水平较干预前增高(P<0.05),但研究组干预后TF、PA、ALB水平虽略高于对照组,但二者比较无显著差异;(3)两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)干预后水平增高(P<0.05),但研究组干预后CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平虽略高于对照组,但二者比较无显著差异;(4)研究组营养达标率较对照组高,营养支持中断发生率较对照组低(P<0.05);(5)研究组腹胀、呕吐的发生率(4.88%)明显低于对照组(21.95%)(P<0.05).但两组吸入性肺炎及腹泻的发生率比较无显著差异.结论腹内压联合24 h胃残余量监测调适的肠内营养方案在呼吸科ICU鼻饲患者中具有较高应用价值,可改善患者机体营养状态及免疫功能,提高生存质量,减少不良事件发生.

一种新型膀胱压测量装置的设计与应用

膀胱压是反应患者腹腔压力的一组重要数据,是护理工作的重要内容。本研究介绍了一款实用新型膀胱压测量装置的设计和使用方法,其能够方便快捷准确的获取患者膀胱压力数值,有利于患者病情的观察,同时减轻医护人员的工作负荷,提高工作效率。