陈秀芹 吴泳锐 李梅

【摘 要】目的：对床边超声监测胃残余量在危重者肠内营养中的应用价值进行分析。方法：选取2018年9月到2019年7月期间我院重症医学科（ICU）收治的70例行持续肠内营养的重症患者，依据随机数字表法分为对照组（n=35）与观察组（n=35），对照组采用空针回抽法，每8小时对患者胃残余量进行监测并调整肠内营养方案。观察组采取床边超声检测胃残余量，每日监测1次，对肠内营养进行实施指导。对两组患者临床表现进行对比。结果：观察组胃内容物反流及误吸发生率、肠内营养中断情况、达到目标喂养、血浆总蛋白、调整肠内营养时间及住ICU时间等指标与对照组相比，差异有统计学意义（P<0.05）。结论：在危重者肠内营养中应用床边超声监测胃残余量具有显著价值，可改善患者预后，缩短住ICU时间，建立友好护患关系，值得推广。

【关键词】床边超声监测;胃残余量;危重者;肠内营养

Abstract： objective： To analyze the application value of bedside ultrasound monitoring of gastric residual amount in enteral nutrition of critically ill patients. Methods ： A total of 40 patients with severe enteral nutrition were enrolled in the Department of Critical Care Medicine （ICU） from January 1， 2017 to June 30， 2018.According to the random number table method were divided into control group （n=20） and observation group （n=20）.The control group was treated with empty needle withdrawal， and the patient's gastric residual was monitored every 8 hours and the enteral nutrition program was adjusted. The observation group received bedside ultrasound to detect the residual amount of the stomach， and was monitored once a day to guide the implementation of enteral nutrition. The clinical manifestations of the two groups of patients were compared.Results： Compared with the control group， there were significant differences in the incidence of reflux and aspiration of gastric contents， interruption of enteral nutrition， target feeding， total plasma protein， adjustment of enteral nutrition time and time in ICU in the observation group （P < 0.05）. Conclusion： The use of bedside ultrasound to monitor gastric residual volume in enteral nutrition of critically ill patients has significant value， which can improve the prognosis of patients， shorten the time of ICU， and establish a friendly relationship between nurses and patients.

Keywords： Bedside ultrasound monitoring; Gastric residual volume; Critically ill; Enteral nutrition

【中圖分类号】R416【文献标识码】A【文章编号】1672-3783（2020）04-12--01

危重症患者早期采取肠内营养对患者肠粘膜完整性具有保护作用，可能提高患者生存率，提高机体免疫功能[1]。但是此类患者经常会出现胃肠蠕动较缓慢，胃内容物反流等现象，致使发生吸入性肺炎，因此对其进行胃残余量监测十分必要[2]。以往胃残余量测定工作主要是通过注射器间断回抽胃管的方式进行，近年来，开始在重症患者的临床中应用床边超声，利用超声对胃窦面积测量的方式对胃残余量进行间接估算，在营养治疗的指导工作中占据着非常重要的位置，能够为重症患者营养治疗以及营养监测奠定良好的基础。本文以收治的70例行持续肠内营养的重症患者作为本次研究对象，部分患者采用空针回抽法，部分选用床边超声检测胃残余量，对两组患者临床表现进行分析。……