ICU机械通气患者肠内营养不同输注速度对腹内压及喂养不耐受的影响
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摘要
将120例ICU机械通气的患者随机分为A、B、C三组,患者肠内营养输注的初始速度分别为:A组为20 mL/h(n=40)、B组为40 mL/h(n=40)、C组为60 mL/h(n=40),三组均逐渐增速至100 mL/h持续输注,比较24 h内3种肠内营养输注速度下腹内压变化、喂养不耐受的发生情况.结果发现:A组患者24 h内腹内压变化无统计学差异(P>0.05);B组患者的腹内压变化在16 h时与C组患者的腹内压变化在8 h时均升高,差异具有统计学意义(P<0.05);24 h内B、C两组喂养不耐受的发生率均高于A组(P<0.05),其中C组喂养不耐受的发生率最高为45%,其主要症状为肠鸣音减弱或消失;初始肠内营养速度为20 mL/h时,对患者的腹内压变化无明显影响,喂养不耐受的发生率最低,更适用于ICU机械通气患者.
120 patients with ICU mechanical ventilation were randomly divided into three groups: A, B, and C. The initial rates of enteral nutrition infusion were 20 mL/h(n=40) in group A and 40 mL/h in group B( n=40), group C was 90 mL/h(n=40), and then the three groups gradually increased to 60 mL/h continuous infusion, so as to compare the changes of intra-abdominal pressure and the incidence of feeding intolerance in three enteral nutrition infusion rates within 24 hours. The results showed that there was no significant difference in intra-abdominal pressure of group A within 24 hours(P>0.05). The intra abdominal pressure of patients in group B increased at 16 h and the intra abdominal pressure of group C increased at 8 h, the difference was statistically significant(P<0.05). The incidence of feeding intolerance in group B and C was higher than that in group A within 24 hours(P<0.05), and the incidence of feeding intolerance in group C was the highest(45%). The main symptom was weakened bowel sound or disappear. Conclusion: When the initial enteral nutrition rate is 20 mL/h, it has no significant effect on the change of intra-abdominal pressure of patients. The incidence of feeding intolerance is the lowest, which is more suitable for patients with mechanical ventilation in ICU.
120 patients with ICU mechanical ventilation were randomly divided into three groups: A, B, and C. The initial rates of enteral nutrition infusion were 20 mL/h(n=40) in group A and 40 mL/h in group B( n=40), group C was 90 mL/h(n=40), and then the three groups gradually increased to 60 mL/h continuous infusion, so as to compare the changes of intra-abdominal pressure and the incidence of feeding intolerance in three enteral nutrition infusion rates within 24 hours. The results showed that there was no significant difference in intra-abdominal pressure of group A within 24 hours(P>0.05). The intra abdominal pressure of patients in group B increased at 16 h and the intra abdominal pressure of group C increased at 8 h, the difference was statistically significant(P<0.05). The incidence of feeding intolerance in group B and C was higher than that in group A within 24 hours(P<0.05), and the incidence of feeding intolerance in group C was the highest(45%). The main symptom was weakened bowel sound or disappear. Conclusion: When the initial enteral nutrition rate is 20 mL/h, it has no significant effect on the change of intra-abdominal pressure of patients. The incidence of feeding intolerance is the lowest, which is more suitable for patients with mechanical ventilation in ICU.
引文
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[5] 邓云霞,徐正梅,孙志琴.肠内营养输注速度对呼吸衰竭机械通气病人腹内压和肺顺应性的影响[J].肠外与肠内营养,2016(4):254-256.
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[9] HART G K,DOBB G J.Effect of a fecal bulking agent on diarrhea during enteral feeding in the critically ill[J].JPEN J Parenter Enteral Nutr,1988,12(5):465-468.
[10] 宋建伟,王玲,孙敏.呼吸机依赖患者营养支持及研究进展[J].齐鲁护理杂志,2015,21(17):54-56.
[11] 程伟鹤,刘华平,史冬雷,等.机械通气患者腹内压与肠内营养喂养不耐受的相关性研究[J].中国护理管理,2018,18(3):361-367.
[12] METHENY N A,MILLS A C,STEWART B J.Monitoring for intolerance to gastric tube feedings:a national survey[J].Am J Crit Care,2012,21(2):33-40.
[13] 邓云霞,孙志琴,徐正梅,等.ICU病人早期肠内营养输注速度与腹内压的相关性研究[J].肠外与肠内营养,2014,21(5):311-312.
[2] 程伟鹤,鲁梅珊,郭海凌,等.危重症患者早期肠内营养喂养不耐受的研究进展[J].中华护理杂志,2017,52(1):98-102.
[3] 周田田,蒋一诺,邹圣强.重症监护室患者肠内营养喂养不耐受的研究进展[J].中华灾害救援医学,2018,6(11):656-660.
[4] 孟海艳.不同肠内营养输注方式对ICU重症病人营养耐受情况的影响[D].吉林:吉林大学,2014:1-44.
[5] 邓云霞,徐正梅,孙志琴.肠内营养输注速度对呼吸衰竭机械通气病人腹内压和肺顺应性的影响[J].肠外与肠内营养,2016(4):254-256.
[6] TAYLOR B E,MCCLAVE S A,MARTINDALE R G,et al.Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient:society of critical care medicine (SCCM) and american society for parenteral and enteral nutrition (A.S.P.E.N.)[J].Crit Care Med,2016,44(2):390-438.
[7] KIRKPATRICK A W,ROBERTS D J,De WAELE J,et al.Intra-abdominal hypertension and the abdominal compartment syndrome:updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome[J].Intensive Care Med,2013,39(7):1 190-1 206.
[8] REINTAM B A,MALBRAIN M L,STARKOPF J,et al.Gastrointestinal function in intensive care patients:terminology,definitions and management.Recommendations of the ESICM Working Group on Abdominal Problems[J].Intensive Care Med,2012,38(3):384-394.
[9] HART G K,DOBB G J.Effect of a fecal bulking agent on diarrhea during enteral feeding in the critically ill[J].JPEN J Parenter Enteral Nutr,1988,12(5):465-468.
[10] 宋建伟,王玲,孙敏.呼吸机依赖患者营养支持及研究进展[J].齐鲁护理杂志,2015,21(17):54-56.
[11] 程伟鹤,刘华平,史冬雷,等.机械通气患者腹内压与肠内营养喂养不耐受的相关性研究[J].中国护理管理,2018,18(3):361-367.
[12] METHENY N A,MILLS A C,STEWART B J.Monitoring for intolerance to gastric tube feedings:a national survey[J].Am J Crit Care,2012,21(2):33-40.
[13] 邓云霞,孙志琴,徐正梅,等.ICU病人早期肠内营养输注速度与腹内压的相关性研究[J].肠外与肠内营养,2014,21(5):311-312.