俯卧位通气时间对重症肺炎合并胃肠功能障碍患者肠内营养耐受性的影响

doi:10.20223/j.cnki.1000-8535.2026.02.008

摘要/Abstract

摘要： 目的本研究旨在探讨不同俯卧位通气（PPV）时间对重症肺炎合并胃肠功能障碍患者肠内营养耐受性的影响。方法选择2020年7月—2023年7月在天津市人民医院重症监护病房（MICU）治疗的80例重症肺炎合并胃肠功能障碍患者为研究对象,按每日PPV时间分为长时组（≥12 h,n=40）和短时组（<12 h,n=40）。比较两组患者一般资料、氧合指数、胃肠功能指标[腹内压、血清促胃液素（GAS）和血管活性肠肽（VIP）]、肠内营养达标率、胃肠并发症率等。结果短时组治疗后,1 d、3 d、5 d氧合指数为（189.93±33.72）、（247.53±63.01）、（325.03±58.11）mmHg,高于长时组的（161.63±36.88）、（191.83±57.65）、（267.95±46.25）mmHg,均P<0.05;胃残留量为（29.00±7.92）、（19.75±4.45）、（11.00±1.87） mL低于长时组的（75.03±23.29）、（53.13±11.99）、（21.70±5.52） mL,均P<0.05。短时组治疗后腹内压[（8.53±2.05）mmHg vs （9.75±2.05） mmHg]、VIP水平[（61.14±7.63） vs （67.49±4.43） pg/mL]低于长时组,GAS水平[（65.02±8.84） vs （54.22±9.21）pg/mL]升高（均P<0.05）。短时组总胃肠并发症发生率（7.50%）低于长时组（25.00%）,P=0.034。结论对于重症肺炎合并胃肠功能障碍患者,每日PPV时间≤12 h可改善氧合并降低胃肠并发症风险,可能与减轻腹压、调节胃肠激素分泌及提升肠内营养耐受性相关。

关键词: 俯卧位通气, 重症肺炎, 胃肠功能障碍, 肠内营养耐受性

Abstract: Objective To explore the effect of different duration of prone position ventilation（PPV）on enteral nutritional tolerance in patients with severe pneumonia combined with gastrointestinal dysfunction．Methods A total of 80 patients with severe pneumonia complicated by gastrointestinal dysfunction were treated in the Medical Intensive Care Unit（MICU）of a hospital from July 2020 to July 2023,and were selected as the research subjects．They were divided into the long-duration group（≥12 hours,n=40）and the short-duration group（<12 hours,n=40）according to the daily duration of PPV．The general data,oxygenation index,gastrointestinal function indicators（intra-abdominal pressure,serum gastrin[GAS] and vasoactive intestinal peptide[VIP]）,enteral nutrition achievement rate,and gastrointestinal complications of the two groups were compared．Results The oxygenation index of the short-duration group at 1 d,3 d,and 5 d after treatment（[189.93±33.72],[247.53±63.01],and[325.03±58.11] mmHg,respectively）was significantly higher than that of the long-duration group（[161.63±36.88],[191.83±57.65],and[267.95±46.25] mmHg,respectively,all P<0.05）．The gastric residual volume of the short-duration group（[29.00±7.92],[19.75±4.45],and[11.00±1.87] mL,respectively）was significantly lower than that of the long-duration group（[75.03±23.29],[53.13±11.99],and[21.70±5.52] mL,respectively,all P<0.05）．The intra-abdominal pressure（[8.53±2.05] vs [9.75±2.05] mmHg）and VIP level（[61.14±7.63] vs [67.49±4.43] pg/mL）of the short-duration group after treatment were significantly lower than those of the long-duration group,while the GAS level（[65.02±8.84] vs [54.22±9.21] pg/mL）was significantly higher（all P<0.05）．The total incidence of gastrointestinal complications in the short-duration group（7.50%）was significantly lower than that in the long-duration group（25.00%,P=0.034）．Conclusions For patients with severe pneumonia complicated by gastrointestinal dysfunction,a daily duration of PPV within 12 hours can improve oxygenation and reduce the risk of gastrointestinal complications,which may be related to the reduction of intra-abdominal pressure,regulation of gastrointestinal hormone secretion,and improvement of enteral nutrition tolerance．

Key words: prone position ventilation, severe pneumonia, gastrointestinal dysfunction, enteral nutrition tolerance

杜维婷, 刘扬, 王晓庆, 郝明明, 张秀娟. 俯卧位通气时间对重症肺炎合并胃肠功能障碍患者肠内营养耐受性的影响[J]. 广州医药, 2026, 57(2): 182-187.

DU Weiting, LIU Yang, WANG Xiaoqing, HAO Mingming, ZHANG Xiujuan. The impact of prone position ventilation duration on the intolerance of enteral nutrition in patients with severe pneumonia combined with gastrointestinal dysfunction[J]. Guangzhou Medical Journal, 2026, 57(2): 182-187.

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