马盈盈　吴琴江　段孟岐

摘要：目的 探讨腹内压水平对危重患者实施早期肠内营养的影响。方法 选择符合纳入标准的患者入组。在肠内营养实施前测量腹内压作为基线水平。将腹内压>15 mmHg作为腹内压升高组，腹内压<15 mmHg作为腹内压正常组。比较两组肠内营养耐受情况、APACHEⅡ评分等指标。结果 腹内压水平与危重患者疾病严重程度密切相关。腹内压升高组APACHEⅡ评分与腹内压正常组评分有统计学差异。腹内压升高组腹泻发生率与正常组有统计学差异，腹胀发生率无统计学差异。结论 腹内压水平越高，出现肠内营养并发症越多，中断营养的机率越高。危重患者实施早期肠内营养应严密监测腹内压水平，可有效预防并发症，提高肠内营养成功率。

关键词：腹内压；危重患者；肠内营养

Abstract：Objective To investigate the effect of intra-abdominal pressure level of early enteral nutrition in critically ill patients.Methods According to inclusion criteria were enrolled.The implementation of enteral nutrition in measuring intra-abdominal pressure as the baseline level.The intra-abdominal pressure>15 mmHg as the intra-abdominal pressure group，<15 mmHg as the intra-abdominal pressure normal group intra-abdominal pressure.Nutrition tolerance between the two groups in the gut，APACHE II score indicators.Results The intra-abdominal pressure and critical level is closely related to disease severity.Elevated intra-abdominal pressure group APACHE score and intra-abdominal pressure normal group score had significant difference.The incidence of diarrhea elevated group had statistically significant difference between normal group and intra-abdominal pressure，the incidence rate of abdominal distension significant difference.Conclusion The higher the level of intra-abdominal pressure，the more complications of enteral nutrition，the higher the probability of interruption of nutrition.Early enteral nutrition should be closely monitored the implementation level of intra-abdominal pressure in critically ill patients，can effectively prevent the complications，improve the success rate of enteral nutrition.

Key words：Intra-abdominal pressure；Critical patients；Enteral nutrition

腹內压（Intra-abdominal pressure IAP）是ICU危重患者重要的生理参数之一，而肠道是对腹内压升高反应最敏感、受影响最早的器官[1]。腹内压持续增高可压迫肠系膜静脉导致肠道水肿，胃肠血液灌注减少，肠系膜屏障受损，胃肠动力下降。危重患者在充分复苏和血流动力学稳定后，尽早开始肠内营养治疗已得到危重症医学界的广泛共识[2]。本研究通过分析不同腹内压水平对危重患者实施早期肠内营养的影响，提高肠内营养实施的成功率。

1资料与方法

1.1 一般资料 选择2014年10月～2015年12月本院外科重症监护病房收治需进行早期肠内营养、ICU住院时间至少72h以上患者纳入本研究。共纳入病例55例。年龄18～91岁，平均年龄（60.8±18.8）岁。本研究对象以男性为主，占63.6%，女性占36.4%，男女比例为1：0.57。腹内压正常组共21例，腹内压升高组共34例。85%的患者为术后患者。患者入ICU后开始肠内营养的平均时间（18.55±17.27）h，41.82%的患者（23例）采用幽门后喂养方式。排除标准：肠内营养实施前存在消化道炎性疾病或肠道菌群失调、血流动力学不稳定、既往有膀胱手术史。

1.2方法 符合纳入标准的危重患者在入住ICU 24 h内收集一般临床资料，急性生理和慢性健康状况评分（APACHEⅡ）在当天肠内营养前完成。ICU住院24～48 h内，在血流动力学稳定且无肠内营养禁忌症情况下实施肠内营养。营……