床旁超聲監測胃殘余量指導重癥患者腸內營養的應用觀察

陳偉花

【摘要】 目的：觀察床旁超聲監測胃殘余量指導重癥患者腸內營養的應用效果。方法：選取2017年5月-2018年5月本院收治的60例重癥患者，均提供長期腸內營養治療。按照隨機數字表法將其分為觀察組與對照組，各30例。觀察組行床旁超聲監測胃殘余量指導下腸內營養治療，對照組采用回抽胃液法干預。比較兩組并發癥發生情況、腸內營養達標時間、血漿總蛋白、調整腸內營養時間、對腸內營養治療依從率。結果：觀察組并發癥發生率為13.33%，低于對照組的40.00%（字2=18.187，P=0.000）;觀察組腸內營養達標時間、調整腸內營養時間均短于對照組，血漿總蛋白水平高于對照組，比較差異均有統計學意義（P<0.05）;觀察組對腸內營養治療完全依從率高于對照組，部分依從率、不依從率均低于對照組，比較差異均有統計學意義（P<0.05）。結論：醫護人員為重癥患者提供床旁超聲監測胃殘余量指導下腸內營養治療，可降低并發癥發生率，提高患者血漿總蛋白，縮短腸內營養治療時間。

【關鍵詞】 超聲; 胃殘余量; 腸內營養; 危急重癥; 并發癥

Effect Observation of Gastric Residual Volume Monitoring under Bedside Ultrasound Guidance for Critical Patients Enteral Nutrition Support/CHEN Weihua.//Medical Innovation of China，2019，16（06）：-162

【Abstract】 Objective：To observe the application of gastric residual volume monitoring under the bedside ultrasound guidance for critical patients enteral nutrition support.Method：A total of 60 critical patients underwent the long-term enteral nutrition therapy from May 2017 to May 2018 in our department were selected.According to the random number table method，they were divided into observation group and control group，30 cases in each group.The observation group was treated with enteral nutrition under the guidance of bedside ultrasound monitoring gastric remnants，while control group was treated with gastric juice withdrawal method.The complications，time of reaching the standard of enteral nutrition，total plasma protein，time of adjusting enteral nutrition and compliance rate of enteral nutrition treatment between two groups were compared.Result：The total incidence of complications in observation group was 13.33%，which was lower than 40.00% in control group

（字2=18.187，P=0.000）.The time of reaching the standard of enteral nutrition and adjusting enteral nutrition in observation group were shorter than those of control group，the total plasma protein level was higher than that of control group，the differences were statistically significant（P<0.05）.The complete compliance rate of enteral nutrition treatment in observation group was higher than that of control group，the partial compliance rate and non-compliance rate were lower than those of control group，the differences were statistically significant（P<0.05）.Conclusion：Medical staff provide bedside ultrasound monitoring of gastric remnants to guide enteral nutrition treatment for critically patients，which can reduce the incidence of complications，increase the total plasma protein of patients，and shorten the time of enteral nutrition treatment.

【Key words】 Ultrasound; Gastric residual volume; Enteral nutrition; Critical illness; Complications

First-authors address：Huizhou Third Peoples Hospital，Huizhou 516001，China

doi：10.3969/j.issn.1674-4985.2019.06.043

危急重癥疾病常見類型包括休克、嚴重創傷、感染、腸道炎性疾病、急性胰腺炎、其他大型手術等患者，病情嚴重情況下可能對患者胃腸黏膜造成刺激，導致消化道功能障礙，其中胃腸動力障礙是主要表現形式。危重癥患者在經歷嚴重疾病或外界創傷后機體多功能處于失衡狀態，失去正常功能，可能存在一個或多個器官功能衰竭現象，直接危及患者生命安全，病情嚴重且發展快，多可能合并其他并發癥共同出現，其中以胃腸功能障礙多見。隨著現代醫學研究的不斷進步，臨床醫師逐漸重視胃腸功能障礙對危重癥患者病情治療進展中的作用。有研究提出胃腸道功能障礙是多器官功能障礙（MODS）的啟動器官、亦是MODS的靶器官，兩者之間存在密切聯系，胃腸功能持續惡化會促進MODS發病，形成惡性循環，但重癥患者早期合并的胃腸功能障礙與機體損害不會直接引起患者死亡;其合并的其他嚴重并發癥是導致死亡的關鍵因素[1]。……