超声监测胃残余量在风心病合并恶液质病人术后肠内营养中的应用
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摘要
目的:床旁超声监测胃残余量在风心病合并恶液质病人术后肠内营养中的应用。方法:收集2015年6月至2017年5月我科收治的60例风湿性瓣膜病心脏恶液质综合征的病人,采用数字表法随机分为2组,A组(常规肠内营养计划+超声监测GRV组)和B组(常规肠内营养计划+胃液回抽监测GRV组),分别根据GRV调整营养方案,从而比较两组营养状态、并发症、营养达标时间和住ICU时间的区别。结果:两组病人在Hb、TP、ALB水平比较上差异有统计学意义(P<0.05),A组营养状态优于B组;两组在胃潴留和肺部感染的发生率上也有统计学意义(P<0.05),A组发生率更低;A、B两组达到目标喂养量时间分别为(3.02±0.78)d、(4.89±0.69)d,A组达到目标喂养量的时间少于B组(t=2.278,P=0.019)。A、B两组住ICU时间两组分别为(10.41±1.98)d、(11.39±1.75)d,A组的住ICU时间少于B组(t=2.384,P=0.015)。结论:床旁超声监GRV可以更准确地指导风心病合并恶液质病人术后病人肠内营养的应用,改善营养状态,更快达到目标喂养量,缩短住ICU住院时间,减少肠内营养相关并发症。
Objective: To investigate the effect of bedside ultrasound in measuring the gastric residual volume in postoperative patients with rheumatic heart disease complicated with cachexia with enteral nutrition support. Method:From June 2015 to May 2017, 60 patients with rheumatic heart disease complicated with cachexia who admitted in ICU were randomly divided into two groups, group A(routine enteral nutrition plan plus ultrasound monitoring GRV) and group B(routine enteral nutrition plan plus withdraw every 4 h to monitor the GRV), to guide the implementation of enteral nutrition. Results: There was significant difference in Hb, TP and ALB levels between the two groups(P < 0.05). The nutritional status of group A was better than that of group B. The incidence of gastric retention and pulmonary infection in group A was significant lower than group B(P <0.05). The length of target feeding time and ICU stay had a statistically difference in group A and group B [(3.02 ± 0.78)d vs(4.89 ± 0.69)d, t=2.278,P=0.019] and [(10.41 ± 1.98)d vs(11.39 ± 1.75)d, t=2.384,P=0.015]. Conclusion: The application of bedside ultrasound to monitor the gastric residual volume can be an accurate method to guide enteral nutrition in postoperative patients with rheumatic heart disease complicated with cachexia, which can improve the nutrition status, shorten the length of target feeding time and ICU stay and reduce enteral nutrition-related complications.
Objective: To investigate the effect of bedside ultrasound in measuring the gastric residual volume in postoperative patients with rheumatic heart disease complicated with cachexia with enteral nutrition support. Method:From June 2015 to May 2017, 60 patients with rheumatic heart disease complicated with cachexia who admitted in ICU were randomly divided into two groups, group A(routine enteral nutrition plan plus ultrasound monitoring GRV) and group B(routine enteral nutrition plan plus withdraw every 4 h to monitor the GRV), to guide the implementation of enteral nutrition. Results: There was significant difference in Hb, TP and ALB levels between the two groups(P < 0.05). The nutritional status of group A was better than that of group B. The incidence of gastric retention and pulmonary infection in group A was significant lower than group B(P <0.05). The length of target feeding time and ICU stay had a statistically difference in group A and group B [(3.02 ± 0.78)d vs(4.89 ± 0.69)d, t=2.278,P=0.019] and [(10.41 ± 1.98)d vs(11.39 ± 1.75)d, t=2.384,P=0.015]. Conclusion: The application of bedside ultrasound to monitor the gastric residual volume can be an accurate method to guide enteral nutrition in postoperative patients with rheumatic heart disease complicated with cachexia, which can improve the nutrition status, shorten the length of target feeding time and ICU stay and reduce enteral nutrition-related complications.
引文
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[8]Kesek DR,Karlsson T,Akerlind L.Early enteral nutrition in the cardiothoracic intensive care unit.Clin Nutr,2002,21(4):303-307.
[9]Singer P,Anbar R,Cohen J,et al.The tight calorie control study(TICACOS):a prospective,randomized,controlled pilot study of nutritional support in critically ill patients.Intensive Care Med,2011,37(4):601-609.
[10]Coriat R,Polin V,Oudjit A,et al.Gastric emptying evaluation by ultrasound prior colonoscopy:An easy tool following bowel preparation.World J Gastroenterol,2014,20(37):13591-13598.
[11]曹岚,叶向红,李君,等.床旁超声监测胃残余量在神经外科重症患者肠内营养中的应用.中华医学杂志,2017,97(9):675-678.
[2]Anker SD,Chua TP,Ponikowski P,et al.Hormonal changes and catabolic/anabolic imbalance in chronic heart failure and their importance for cardiac cachexia.Circulation,1997,96(2):526-534.
[3]Moreira TV,McQuiggan M.Methods for the assessment of gastric emptying in critically ill,enterally fed adults.Nutr Clin Pract,2009,24(2):261-267.
[4]王艺萍,肖菲,潘灵爱等.早期肠内营养对重症心脏瓣膜病病人术后营养状态和免疫功能的研究.肠外与肠内营养,2015,22(3):136-139.
[5]朱家麟.关于危重心脏瓣膜病标准的探讨.中华外科杂志,1994,32(6):323-324.
[6]Van de Putte P,Perlas A.Ultrasound assessment of gastric content and volume.Br J Anaesth,2014,113(1):12-22.
[7]张竞超.风湿性瓣膜病心脏恶液质综合征患者围手术期应用胃肠内营养164例.中国医药指南,2014,12(1):162-163.
[8]Kesek DR,Karlsson T,Akerlind L.Early enteral nutrition in the cardiothoracic intensive care unit.Clin Nutr,2002,21(4):303-307.
[9]Singer P,Anbar R,Cohen J,et al.The tight calorie control study(TICACOS):a prospective,randomized,controlled pilot study of nutritional support in critically ill patients.Intensive Care Med,2011,37(4):601-609.
[10]Coriat R,Polin V,Oudjit A,et al.Gastric emptying evaluation by ultrasound prior colonoscopy:An easy tool following bowel preparation.World J Gastroenterol,2014,20(37):13591-13598.
[11]曹岚,叶向红,李君,等.床旁超声监测胃残余量在神经外科重症患者肠内营养中的应用.中华医学杂志,2017,97(9):675-678.