NICU肠内营养患者误吸与胃残余的相关性研究

发布时间：2018-01-29 19:39

  本文关键词： 肠内营养 误吸 折光仪 胃残余量 胃残余浓度　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:对NICU肠内营养患者误吸与胃残余(胃残余量、胃残余浓度)的相关性进行研究并探讨影响胃残余浓度的因素。方法:收集山西医科大学第一临床医学院2016年6月至2016年12月入住NICU、年龄≥18岁,且经鼻饲饮食给予肠内营养≥4天的患者,排除既往胃食管反流病史、发病前有严重肺部疾病、消化道出血、消化道先天畸形的患者,排除因各种原因不能持续鼻饲进食的患者。所有病人鼻饲喂养时床头抬高30°-45°,使用同一型号鼻胃管、鼻肠管。患者鼻饲营养液有肠内营养乳剂TPF-D(瑞代),肠内营养乳剂TPF-T(瑞能),肠内营养乳剂TP-HE(瑞高)以及肠内营养混悬液TPF1.5(能全力)。患者进行鼻饲肠内营养乳剂后的3天时间内分别于每天10:00-22:00之间每间隔4小时回抽胃残余,利用手持折光仪测定胃内容物的折射率并计算胃残余量和胃残余浓度,同时由专业护士收集痰标本,对痰液标本采用ELISA法进行胃蛋白酶检测,根据胃蛋白酶含量检测结果将患者分为频繁误吸组和非频繁误吸组,按照胃残余浓度分为低、中、高胃残余浓度组,进而分析比较各组之间胃残余浓度、胃残余量等有无统计学差异,寻找影响胃残余浓度的因素。结果:1.纳入NICU患者30例,其中男22例,女8例,年龄36-83岁,平均年龄59.83±14.82岁,GCS评分3-15分,平均8.10±3.01,APACHEⅡ评分14-38分,平均24.93±6.12,监测胃残余量0-310ml,平均(23.02±27.78)ml,胃残余浓度0-100%,平均(50.28±28.13)%。纳入患者中,脑血管病19例,非脑血管病11例,其中脑血管病患者NIHSS评分9-43分,平均24.79±9.07。所有患者中气管插管5例,气管切开2例,呼吸机辅助呼吸4例。共留取痰标本174个。2.以胃蛋白酶含量≥6.5ng/m L为阳性,样本阳性率25%为频繁误吸组,25%为非频繁误吸组,频繁误吸组共16人,非频繁误吸组14人,频繁误吸组GCS评分为7.06±2.79,非频繁误吸组GCS评分为9.29±2.89,两组之间差别具有统计学意义(P=0.041);两组间年龄、性别及鼻饲方式等差别无统计学意义。3.频繁误吸组GRV均数为(27.30±29.75)ml,非频繁误吸组为(18.13±25.55)ml,两组之间差别无统计学意义(P=0.376)。频繁误吸组与非频繁误吸组相比,两组间出现GRV增高(≥50、100、150ml)的次数差别亦无统计学差异。4.频繁误吸组胃残余浓度高于非频繁误吸组,分别为(59.70±28.11)%、(39.53±24.90)%(P=0.048)。对比频繁误吸组与非频繁误吸组中患者不同胃残余浓度出现的次数,当胃残余浓度至少1次出现≥60%、70%、80%时,两组之间差别无统计学意义。然而,当出现至少3次胃残余浓度≥60%、70%时,更易出现频繁误吸;频繁误吸组出现至少2次胃残余浓度≥80%及至少1次≥90%的例数较非频繁误吸组更多。5.按照胃残余浓度不同分为30%、30%-60%以及60%组(即低胃残余浓度、中胃残余浓度和高胃残余浓度组)。NICU患者低、中、高胃残余浓度组相比,GCS评分及脑血管病患者NIHHS评分差别具有统计学意义;不同鼻饲方式在这三组之间差别同样具有统计学意义。结论:对NICU留置鼻饲饮食的患者,监测胃残余量并不能用于评估误吸发生的风险,胃残余量较低时仍存在有误吸频繁发生。误吸更常发生于胃残余浓度较高的患者,监测胃残余浓度及胃残余浓度增高的次数可以评估误吸频繁发生的风险。胃残余浓度受意识障碍程度及鼻饲方式的影响,留置鼻肠管可以明显降低胃残余浓度。
[Abstract]:Objective: the NICU enteral nutrition in patients with gastric aspiration and residual (gastric residual gastric residual concentration) to study the relationship between gastric residual concentration and explore the influencing factors. Methods: We collected the first clinical medical college of Shanxi Medical University from June 2016 to December 2016 in NICU, 18 years of age or older, and by nasal feeding with enteral nutrition is more than 4 day patients, exclude the previous history of gastroesophageal reflux, a serious lung disease, gastrointestinal bleeding, digestive tract malformation were excluded for various reasons can not continue nasal feeding patients. All patients with nasal feeding feeding head elevation 30 -45 degrees, use the same type of nasogastric tube, nasal tube. Patients with nasal feeding nutrient solution (ill), Enteral Nutritional Emulsion TPF-D Enteral Nutritional Emulsion TPF-T (Supportan), Enteral Nutritional Emulsion TP-HE (Philippines) and Enteral Nutritional Suspension TPF1.5 (full power). Patients with nasogastric enteral nutrition After the emulsion 3 days respectively in every 10:00-22:00 between every 4 hours to draw the gastric residual gastric contents determination of refractive index using the handheld refractometer and calculate the residual rate of gastric and gastric residual concentration, at the same time by professional nurses to collect the sputum samples of sputum samples by ELISA method for the detection of pepsin, according to the test results pepsin contents were divided into frequent aspiration group and the non frequent aspiration group, in accordance with the gastric residual concentration is divided into low, high concentration group, gastric residual, and then compared between the residual concentration of stomach, gastric residual volume have no statistical difference, find the influence factors of gastric residual concentration. Results: 1. in 30 NICU patients, male 22 cases, female 8 cases, age 36-83 years, mean age 59.83 + 14.82 years old, GCS score of 3-15 points, an average of 8.10 + 3.01, APACHE score of 14-38 points, an average of 24.93 + 6.12, monitoring residual gastric volume 0-310ml, average (23.02. 27.78)ml,鑳冩畫浣欐祿搴，

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