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

发布时间：2018-04-07 17:16

本文选题：机械通气患者　切入点：肠内营养　出处：《北京协和医学院》2017年硕士论文

【摘要】：研究背景:机械通气患者的肠内营养喂养不耐受发生率高,胃残余量作为喂养不耐受的预测指标其临界值不统一。探究一种新的客观、准确预测喂养不耐受的指标成为临床研究的重点。基于腹内压与胃肠道功能相互影响的病理生理机制,腹内压与肠内营养喂养不耐受的发生可能存在相关性。本研究旨在探究机械通气患者腹内压与喂养不耐受的相关性,以期为预测喂养不耐受的发生,及早采取有效措施,帮助患者肠内营养的顺利进行提供有价值的科学依据。研究目的:探究机械通气患者腹内压与肠内营养喂养不耐受的相关性;探究机械通气患者腹内压对肠内营养喂养不耐受性的预测价值。研究方法:本研究为描述性研究,便利抽取2016年5月～2017年1月,对北京地区某三甲医院重症监护病房进行治疗的110例气管插管的机械通气患者进行调查,于患者肠内营养前及肠内营养后的前3天采用经尿道膀胱压力测量患者的腹内压,并记录患者肠内营养过程中喂养不耐受(肠鸣音减弱或消失、腹泻、胃残余量、便秘、呕吐/反流、胃肠道出血)的发生情况。采用偏相关分析腹内压与喂养不耐受的相关性,采用ROC曲线确定腹内压预测患者喂养不耐受发生的临界值。研究结果:110例机械通气患者腹内压的基线水平和肠内营养前3天腹内压的水平分别为8.6±3.3mmHg和10.8±4.2mmHg,两者之间有统计学差异(P0.01)。患者喂养不耐受的发生率为73.6%,其中最主要的表现为肠鸣音减弱或消失(53.6%)和腹泻(48.2%)。相关分析结果显示腹内压与喂养不耐受呈显著性正相关(P0.01)。基线与肠内营养前3天的腹内压预测患者喂养不耐受的ROC曲线下的AUC依次为0.81(95%CI:0.73～0.89)和0.86(95%CI:0.79～0.93),其预测喂养不耐受发生最佳临界值分别为9mmHg和11mmHg。研究结论:气管插管的机械通气患者,其腹内压与早期肠内营养喂养不耐受的发生呈显著性正相关,当腹内压基线水平≥9mmHg及早期肠内营养前3天腹内压水平≥11mmHg时,应警惕患者喂养不耐受的发生。
[Abstract]:Background: the incidence of enteral feeding intolerance in patients with mechanical ventilation is high and the critical value of gastric remnant as a predictor of feeding intolerance is not uniform.To explore a new objective and accurate predictor of feeding intolerance has become the focus of clinical research.Based on the pathophysiological mechanism of the interaction between intra-abdominal pressure and gastrointestinal function, there may be a correlation between intra-abdominal pressure and enteral feeding intolerance.The purpose of this study was to explore the relationship between intra-abdominal pressure and feeding intolerance in patients with mechanical ventilation, so as to provide a valuable scientific basis for predicting the occurrence of feeding intolerance and taking effective measures as early as possible to help patients with successful enteral nutrition.Objective: to explore the relationship between intra-abdominal pressure and enteral feeding intolerance in patients with mechanical ventilation, and to explore the predictive value of intra-abdominal pressure in patients with mechanical ventilation.Methods: for descriptive study, 110 cases of mechanical ventilation with tracheal intubation were selected from May 2016 to January 2017 in an intensive care unit of a third Class A hospital in Beijing area.The abdominal pressure was measured by transurethral bladder pressure 3 days before and 3 days after enteral nutrition. The feeding intolerance was recorded during enteral nutrition (decreased or disappeared of bowel tone, diarrhea, gastric remnant, constipation).Vomiting / reflux, gastrointestinal bleeding).Partial correlation analysis was used to analyze the correlation between intra-abdominal pressure and feeding intolerance, and ROC curve was used to determine the critical value of intra-abdominal pressure in predicting the occurrence of feeding intolerance in patients.Results the baseline level of intra-abdominal pressure and the level of intra-abdominal pressure 3 days before enteral nutrition were 8.6 卤3.3mmHg and 10.8 卤4.2 mmHg, respectively. There was a significant difference between them (P 0.01).The incidence of feeding intolerance in the patients was 73.6, the main manifestations of which were reduced or disappeared bowel sounds (53.6%) and diarrhea (48.2%).The results of correlation analysis showed that there was a significant positive correlation between intra-abdominal pressure and feeding intolerance (P 0.01).The AUC under the ROC curve of baseline and enteral nutrition for predicting the feeding intolerance of patients was 0.81g 95 CI: 0.73 0.89) and 0.8695 CI: 0.790.790.93, respectively. The best critical values for predicting the incidence of feeding intolerance were 9mmHg and 11mm Hg, respectively.Patients should be on guard against the occurrence of feeding intolerance.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R472.2

【参考文献】