摘要
目的探讨床旁超声监测ICU危重患者肠内营养期间胃残余量和预测喂养不耐受的可行性。方法回顾性分析2018年4~9月浙江大学医学院附属第二医院急诊ICU收治的危重患者,纳入期间因病情需要完成腹部CT检查的患者,同时在CT检查前后30 min内有床旁超声监测胃窦截面积者。所有入选患者使用VOLUME-Work Flow医学图像软件,描记腹部CT中的胃壁轮廓计算胃残余量值。采用Pearson相关性分析评估半坐位、平卧位及右侧卧位胃窦截面积与胃残余量之间的相关性,两个独立样本t检验比较危重患者喂养耐受者与不耐受者胃窦截面积之间的差异,以及ROC曲线分析不同体位下胃窦截面积对患者肠内营养喂养不耐受的预测价值。结果研究共纳入42例患者,年龄为(53±13)岁,平均体质量指数为(21.5±2.8)kg/m2,平均急性生理和慢性健康评估Ⅱ值为17.0±6.9。患者胃残余量为(314.5±126.6)mL,半坐位、平卧位及右侧卧位胃窦截面积值分别为(7.11±4.13)cm2、(4.22±2.66)cm2、(8.36±4.58)cm2。相关性分析显示,胃残余量与半坐位(r=0.543,P<0.001)、平卧位(r=0.604,P<0.001)、右侧卧位(r=0.618,P<0.001)时的胃窦截面积均呈显著正相关。肠内营养期间,危重患者喂养耐受者27例、喂养不耐受者15例,其中喂养不耐受者在半坐位、平卧位及右侧卧位时的胃窦截面积较喂养耐受者显著增加,组间比较差异均有统计学意义[半坐位:(8.53±4.07)cm2vs(4.60±2.76)cm2;平卧位:(5.15±2.75)cm2vs(2.61±1.32)cm2;右侧卧位:(10.32±4.06)cm2vs(4.95±3.20)cm2,均P<0.005]。ROC曲线分析显示,在半坐位、平卧位及右侧卧位时,胃窦截面积预测肠内营养喂养不耐受的ROC曲线下面积分别为0.815、0.833、0.849,以≥3.917 cm2、3.395 cm2与4.402 cm2为阈值时的敏感性分别为92.0%、69.6%、92.3%,特异性分别为69.2%、92.3%、71.4%。结论床旁胃超声能比较准确地评估危重患者的胃残余量,并能有效地预测肠内营养期间喂养不耐受的发生。
Objective To explore the feasibility of bedside ultrasound in monitoring gastric residual volume and predicting feeding intolerance during enteral nutrition in critically ill patients in intensive care unit.Methods The data of critically ill patients admitted to emergency intensive care unit of the Second Affiliated Hospital of Zhejiang University School of Medicine from April 2018 to September 2018 were retrospectively analyzed.The following patients were finally included in this study:(1)abdominal computed tomography during the stay of emergency intensive care unit was performed due to the requirement of disease evaluation and management;(2)bedside ultrasound was performed to measure the gastric antrum cross-sectional area at 30 min prior to or after abdominal computed tomography.The outline of stomach wall in the imaging of abdominal computed tomography was traced with the help of VOLUME-Work Flow medical imaging software to calculate the value of gastric residual volume.The relationship between gastric antrum cross-sectional area under semi-sitting,horizontal and right-lateral positions and gastric residual volume was evaluated by Pearson correlation analysis.The difference of gastric antrum cross-sectional area between those critically ill patients with or without feeding intolerance was compared by independent-sample t test.The predictive value of gastric antrum cross-sectional area under different body positions on feeding intolerance during enteral nutrition was analyzed by ROC curve.Results Totally,forty-two patients were enrolled and analyzed in this study,in which the mean age was(53±13)y,mean body mass index was(21.5±2.8)kg/m2 and mean acute physiology and chronic health evaluation was 17.0±6.9.The value of gastric residual volume was(314.5±126.6)mL,and the values of gastric antrum cross-sectional area under semi-sitting,horizontal and right-lateral positions were(7.11±4.13)cm2,(4.22±2.66)cm2,(8.36±4.58)cm2,respectively.The correlation analysis indicated that gastric residual volume was positively associated with gastric antrum cross-sectional area under semi-sitting,horizontal and right-lateral positions(r=0.543,0.604 and 0.618,respectively;all P<0.001).During enteral nutrition,15 patients experienced feeding intolerance while 27 patients hadn’t feeding intolerance,in which the gastric antrum cross-sectional areas under semi-sitting,horizontal and right-lateral positions were significantly increased in those patients with feeding intolerance than those patients without feeding intolerance[semi-sitting:(8.53±4.07)cm2vs(4.60±2.76)cm2;horizontal position:(5.15±2.75)cm2vs(2.61±1.32)cm2;right-lateral position:(10.32±4.06)cm2vs(4.95±3.20)cm2,all P<0.005].ROC curve analysis showed that the area under ROC curves of gastric antrum cross-sectional area under semi-sitting,horizontal and right-lateral positions for predicting feeding intolerance during enteral nutrition were 0.815,0.833 and 0.849,respectively;when its values≥3.917 cm2,3.395 cm2 and 4.402 cm2 were used as the cut-off points,the sensitivities were 92.0%,69.6%and 92.3%,and the corresponding specificities were 69.2%,92.3%and 71.4%,respectively.Conclusions Bedside gastric ultrasound could accurately evaluate the status of gastric residual volume in critically ill patients,and effectively predict their occurrence of feeding intolerance during enteral nutrition.
作者
陈闯
徐杰丰
刘少云
高玉芝
丁信法
张茂
Chen Chuang;Xu Jiefeng;Liu Shaoyun;Gao Yuzhi;Ding Xinfa;Zhang Mao(Department of Emergency Medicine,Second Affiliated Hospital,School of Medicine and Institute of Emergency Medicine,Zhejiang University,Hangzhou 310009,China;Department of Radiology,Second Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310009,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2020年第10期1291-1295,共5页
Chinese Journal of Emergency Medicine
关键词
危重症
胃超声
腹部CT
胃残余量
胃窦截面积
喂养不耐受
Critical illness
Gastric ultrasound
Abdominal computed tomography
Gastric residual volume
Gastric antrum cross-sectional area
Feeding intolerance
