超声监测导向下早期肠内营养在ICU重症脓毒血症有创通气患者中的应用观察

来源期刊：广州医药 | 1476-1481 发布时间：2025-01-08 收稿时间：2025/11/13 18:42:29 阅读量：43

作者：: 陶剑锋,

邓虹,

张洪举,

黄颖妍,

谭哲君,

成叶娣,

关键词：: 重症脓毒血症有创通气超声监测导向下早期肠内营养营养状况; severe sepsis invasive mechanical ventilation ultrasound monitoring guided early enteral nutrition nutritional status

DOI：: 10.20223/j.cnki.1000-8535.2024.12.014

收稿时间：: 2024-07-17
修订日期：
接收日期：
引用总数：: 0

目的探讨超声监测导向下早期肠内营养（EEN）在重症脓毒血症（SS）有创通气（IV）患者中的应用效果。方法选取2021年2月—2023年11月连州市人民医院收入的115例SS-IV患者,依据随机数字表法分为对照组（n=57）、超声监测组（n=58）。所有患者均予重症监护病房（ICU）综合治疗,在此基础上对照组实施临床经验的传统肠内营养（EN）干预,超声监测组实施超声监测导向下EEN干预,均监测至治疗结束。统计两组IV时间、ICU停留时间、EN达标时间、EN不耐受发生率、相关并发症发生率,比较干预前、EN结束时营养状况[白蛋白（ALB）、总蛋白（TP）、前白蛋白（PA）]、序贯器官衰竭评分（SOFA）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。结果对照组剔除放弃治疗1例,死亡2例,纳入54例;超声监测组剔除放弃治疗1例,死亡1例,纳入56例。超声监测组EN达标时间[（40.18±8.46）h]、IV时间[（7.12±1.44）d]、ICU停留时间[（9.21±1.63）d]短于对照组[（46.03±10.15）h、（8.02±1.62）d、（10.18±1.54）d]（t=3.288、3.082、3.206,均P<0.05）。EN结束时超声监测组SS-IV患者血清ALB[（32.05±3.13）g/L]、TP[（65.36±3.62）g/L]、PA[（0.24±0.06）g/L]高于对照组[（30.28±2.24）g/L、（63.28±4.24）g/L、（0.21±0.05）g/L]（t=3.400、2.770、2.843,均P<0.05）。EN结束时超声监测组APACHEⅡ评分[（15.85±1.93）分]、SOFA评分[（7.42±1.64）分]低于对照组[（17.02±2.04）分、（8.35±2.03）分]（t=3.091、2.648,均P<0.05）。超声监测组EN不耐受发生率[12.50%（7/56）]低于对照组[29.63%（16/54）],超声监测组相关并发症发生率[8.93%（5/56）]低于对照组[24.07%（13/54）]（χ²=4.878、4.608,均P<0.05）。结论超声监测导向下EEN干预应用于SS-IV患者,可改善患者病情与营养状况,降低EN不耐受及相关并发症发生风险,缩短恢复时间。

Objective To investigate the effect of ultrasound monitoring guided early enteral nutrition（EEN）in patients with severe sepsis（SS）and invasive mechanical ventilation（IV）．Methods A total of 115 SS-IV patients admitted to Lianzhou People's Hospital from February 2021 to November 2023 were randomly divided into control group（n=57）and ultrasound monitoring group（n=58）．All patients were given comprehensive treatment in intensive care unit（ICU）．On this basis,traditional enteral nutrition（EN）intervention with clinical experience was implemented in control group,and EEN intervention guided by ultrasonic monitoring was implemented in ultrasound monitoring group．All patients were monitored until the end of treatment．IV time,ICU stay time,EN compliance time,incidence of EN intolerance,and incidence of related complications were analyzed in the 2 groups．Nutritional status [albumin（ALB）,total protein（TP）,prealbumin（PA）],sequential organ failure assessment（SOFA）,acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）were compared before intervention and at the end of EN．Results In control group,1 cases gave up,2 cases died,and 54 cases were included．In ultrasound monitoring group,1 case gave up,1 case died,and 56 cases were included．The EN compliance time [（40.18±8.46）h],IV time [（7.12±1.44）d] and ICU stay time [（9.21±1.63）d] of ultrasound monitoring group were shorter than those of control group [（46.03±10.15）h,（8.02±1.62）d,（10.18±1.54）d]（t=3.288,3.082,3.206,all P<0.05）．At the end of EN,serum ALB[（32.05±3.13）g/L],TP[（65.36±3.62）g/L],PA[（0.24±0.06）g/L] of SS-IV patients in ultrasound monitoring group were higher than those in control group [（30.28±2.24）g/L,（63.28±4.24）g/L,（0.21±0.05）g/L]（t=3.400,2.770,2.843,all P<0.05）．At the end of EN,APACHEⅡ scores [（15.85±1.93）points] and SOFA scores [（7.42±1.64）points] of ultrasound monitoring group were lower than those of control group [（17.02±2.04）points and（8.35±2.03）points]（t=3.091,2.648,all P<0.05）．The incidence of EN intolerance in ultrasound monitoring group [12.50%（7/56）] was lower than that in control group [29.63%（16/54）],and the incidence of related complications in ultrasound monitoring group [8.93%（5/56）] was lower than that in control group [24.07%（13/54）]（χ²=4.878,4.608,all P<0.05）．Conclusions EEN intervention guided by ultrasonic monitoring in SS-IV patients can improve the nutritional status of patients,reduce the risk of EN intolerance and related complications,shorten the recovery time,and reduce the progression of patients' disease．

1、夏春洁. 超早期肠内营养支持护理对重症颅脑损伤患者营养状态、康复进程的影响[J].中华现代护理杂志,2022,28(12):1663-1666.

2、任志方,张博寒,陈烁,等.床旁超声监测和注射器回抽法对肠内营养实施效果的Meta分析[J].卫生职业教育,2022,40(13):152-159.

3、 LANDAIS M,NAY MA,AUCHABIE J,et al.Continued enteral nutrition until extubation compared with fasting before extubation in patients in the intensive care unit:an open-label,cluster-randomised,parallel-group,non-inferiority trial[J].Lancet Respir Med,2023,11(4):319-328.

4、 YASUDA H,KONDO N,YAMAMOTO R,et al.Monitoring of gastric residual volume during enteral nutrition[J].Cochrane Database Syst Rev,2021,9(9):CD013335.

5、傅园花,郭莉娟,葛国平.床旁超声监测胃残余量对机械通气患者肠内营养耐受性的影响[J].中国中西医结合急救杂志,2019,26(3):326-328.

6、潘升付,李智,张璐,等.静息能量代谢测定在老年脓毒症患者营养支持中的价值[J].老年医学与保健,2022,28(6):1187-1190.

7、康健,李筠璐,郑富文,等.床旁超声监测脓毒症患者胃肠功能障碍的研究进展[J].中华急诊医学杂志,2020,29(1):133-137.

8、王迎秋,侯仁花,刘艳,等.不同测量方法对核素胃排空显像结果影响的研究[J].标记免疫分析与临床,2022,29(8):1388-1391,1405.

9、赵庆华,皮红英,周颖.ICU住院患者胃残余量监测相关情况调查分析[J].护士进修杂志,2017,32(6):553-556.

10、陈文秀,孙加奎,沈骁,等.早期肠内营养对脓毒症病人Th17/Treg细胞比及IL-23/IL-17轴的调节与临床意义[J].肠外与肠内营养,2019,26(1):30-34.

11、李兰香,陈惠瑶.标准化喂养流程对脓毒症患者肠内营养耐受性的影响[J].国际医药卫生导报,2024,30(2):343-347.

12、卢延发. 序贯器官衰竭评分联合可溶性程序性死亡因子-1对脓毒症患者的预后的影响[J].广州医药,2021,52(6):87-89.

13、崔庆. 理气通腑汤治疗脓毒症胃肠功能障碍疗效及对胃肠黏膜屏蔽功能和胃肠动力的影响[J].现代中西医结合杂志,2021,30(15):1685-1688,1710.

14、上海市中西医结合学会急救专业委员会,上海市中西医结合学会重症医学专业委员会,上海市医师协会急诊科医师分会,等.脓毒症急性胃肠功能障碍中西医结合临床专家共识[J].中华危重病急救医学,2022,34(2):113-120.

15、卓坚臻,石紫筠,童辉纯,等.血清PCT联合AG检测对脓毒症患者预后的预测价值[J].广州医药,2022,53(3):66-69.

16、 HERWALD H,EGESTEN A.Serious,severe,sepsis[J].J Innate Immun,2020,12(2):129-130.

17、赵明曦,孙建华,李奇,等.床旁超声评估重症患者胃肠功能的最佳证据总结[J].中华现代护理杂志,2022,28(5):602-610.

18、 PERLAS A,MITSAKAKIS N,LIU L,et al.Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination[J].Anesth Analg,2013,116(2):357-363.

19、 SINGER M,DEUTSCHMAN C S,SEYMOUR C W,et al.The third international consensus definitions for sepsis and septic shock(sepsis-3)[J].JAMA,2016,315(8):801-810.

20、何聪,王显雷,付优,等.床旁胃肠超声联合肠内营养耐受性评分在中重症急性胰腺炎患者营养治疗中的作用[J].山东医药,2022,62(19):24-27.

21、余昆容,李梅,赵淑雅,等.注射器抽吸监测胃残余量对ICU病人呕吐、摄入热量及预后影响研究[J].肠外与肠内营养,2021,28(2):95-99.

22、王尼尼,鲍昱含,姜巍,等.有创机械通气危重患者胃肠功能障碍辨证量表理论框架构建[J].中国中西医结合消化杂志,2020,28(8):585-589.

23、陆碧燕,李杏崧,马杏婵.PICCO监测在重度脓毒症患者液体管理中的应用研究[J].国际医药卫生导报,2021,27(22):3505-3508.

24、 XIE J,WANG H,KANG Y,et al.The epidemiology of sepsis in Chinese ICUs:A national cross-sectional survey[J].Crit Care Med,2020,48(3):e209-e218.

25、 CHIU C,LEGRAND M.Epidemiology of sepsis and septic shock[J].Curr Opin Anaesthesiol,2021,34(2):71-76.