背景:胃残留监测是评估机械通气患者胃排空的重要方法。通过监测胃内容物,肠内营养方案可以及时调整,以确保喂养安全。
目的:探讨超声监测对喂养并发症发生率的影响,重症机械通气患者每日热量摄入与预后的关系.分析超声监测胃残余容积(GRV)达250mL的临床意义,为临床实践提供理论依据。
方法:南通大学附属医院急诊科2018年1月至2022年6月收治的入院后24~48h内接受有创机械通气和持续肠内营养支持的患者。对住院7d内患者的病历进行回顾性分析,比较喂养并发症的发生率,胃残留≥250mL和<250mL患者的每日热量摄入与临床预后,在第三天通过超声波监测。
结果:本研究共纳入513例患者。腹胀的发生率,腹泻,<250mL和≥250mL组的呕吐分别为:18.4%和21.0%,23.9%比32.3%和4.0%比6.5%,死亡率分别为20.8%和22.65%;机械通气持续时间分别为18.30d和17.56d,而在重症监护病房(ICU)的住院时间分别为19.87d和19.19±5.19d。组间上述因素差异无统计学意义。胃残留≥250mL不是死亡和ICU住院时间延长的独立危险因素。然而,≥250mL组患者的目标喂养时间长于≥250mL组患者,≥250mL组患者住院第4天至第7天的热量摄入(22.0、23.6、24.8、25.3kcal/kg/d)低于≥250mL组患者(23.2、24.8、25.7、25.8kcal/kg/d)。第4天(Z=4.324,P=0.013),第5天(Z=3.376,P=0.033),而在第6天(Z=3.098,P=0.04),差异有统计学意义。
结论:当监测值≥250mL时,使用超声监测GRV并进行临床干预对喂养并发症的发生率和临床预后结果没有显著影响。然而,它显著延长了达到目标喂养的时间,减少ICU住院期间的每日卡路里摄入量,并增加患者营养不足的风险。应进一步研究监测胃残留物和监测频率的准确性和必要性。
BACKGROUND: Monitoring of gastric residual is an important approach for assessing gastric emptying in patients with mechanical ventilation. By monitoring gastric contents, the enteral nutrition scheme can be adjusted in time to ensure feeding safety.
OBJECTIVE: To investigate the effects of ultrasound monitoring on the incidence of feeding complications, daily caloric intake and prognosis of patients with severe mechanical ventilation. To analyze the clinical significance of ultrasound monitoring of gastric residual volume (GRV) up to 250 mL to provide a theoretical basis for clinical practice.
METHODS: Patients admitted to the department of emergency medicine of the Affiliated Hospital of Nantong University from January 2018 to June 2022 who received invasive mechanical ventilation and continuous enteral nutrition support within 24-48 h after admission were enrolled in this study. Medical records for patients within 7 d of hospitalization were retrospectively analyzed to compare the incidence of feeding complications, daily caloric intake and clinical prognosis between patients with gastric residual ≥ 250 mL and < 250 mL, as monitored by ultrasound on the third day.
RESULTS: A total of 513 patients were enrolled in this study. Incidences of abdominal distension, diarrhea, and vomiting in the < 250 mL and ≥ 250 mL groups were: 18.4% vs 21.0%, 23.9% vs 32.3% and 4.0% vs 6.5%, respectively; mortality rates were 20.8% vs 22.65%; mechanical ventilation durations were 18.30 d vs 17.56 d while lengths of stay in the intensive care units (ICU) were 19.87 d vs 19.19 ± 5.19 d. Differences in the above factors between groups were not significant. Gastric residual ≥ 250 mL was not an independent risk factor for death and prolonged ICU stay. However, target feeding time of patients in the ≥ 250 mL group was longer than that of patients in the ≥ 250 mL group, and caloric intake (22.0, 23.6, 24.8, 25.3 kcal/kg/d) for patients in the ≥ 250 mL group from the 4th day to the 7th day of hospitalization was lower than that of patients in the ≥ 250 mL group (23.2, 24.8, 25.7, 25.8 kcal/kg/d). On the 4th day (Z = 4.324, P = 0.013), on the 5th day (Z = 3.376, P = 0.033), while on the 6th day (Z = 3.098, P = 0.04), the differences were statistically significant.
CONCLUSIONS: The use of ultrasound to monitor GRV and undertaking clinical interventions when the monitoring value is ≥ 250 mL has no significant effects on incidences of feeding complications and clinical prognostic outcomes, however, it significantly prolongs the time to reach target feeding, reduces the daily intake of calories during ICU hospitalization, and increases the risk of insufficient nutrition of patients. The accuracy and necessity of monitoring gastric remnants and monitoring frequencies should be investigated further.