腹内压对胃潴留的影响及其临界值观察

Effect of intra-abdominal pressure on gastric retention and observation of its critical value

摘要:

目的 通过监测患者腹腔内压变化观察其对胃潴留的影响，寻找胃潴留时的腹内压值，观察胃潴 留与急性生理学与慢性健康状况评分系统Ⅱ（APACHE- Ⅱ）评分的相关性。方法 选取2014 年8 月-2016 年11 月入住该院重症监护病房的患者，留置导尿管、鼻胃管及给予鼻饲能全力液（1 ml ：1 kcal，500 ml/ 瓶 1 kcal=4.184kj）。腹内压监测时无使用胃肠动力药物及长期使用镇静药物。用膀胱测压法测腹内压，4 次/ d，鼻饲后1 和12 h 后各测2 次，每次取平均值。营养方式为鼻胃管微泵加温（37 ～ 40℃）鼻饲，第1 天速 度50 ml/h，如果通畅，第2 天及之后为50 ～ 100 ml/h，如不畅改为50 ml/h。如果出现胃潴留，即时测腹 内压2 次，取平均值。潴留后第2 天则鼻饲温开水观察何时通畅。对所有患者进行APACHE- Ⅱ评分。结 果 ①腹内压平均值为（9.8±1.5）mmHg。腹腔内高压发生率为64.7%。胃潴留发生率为33.6%。与非腹内 高压组比较，腹内高压组胃潴留发生率高（P <0.05）；②胃潴留时腹内压平均值为（17.4±0.4）mmHg ；③胃 潴留组与非潴留组APACHE- Ⅱ评分平均值分别为（19.7±3.6）和（12.0±2.5）分，两组比较，胃潴留组的 APACHE- Ⅱ评分更高（P <0.05）。结论 ICU 中患者腹内压常升高，腹内压升高至（17.4±0.4）mmHg 时 鼻胃管鼻饲能全力液患者易出现胃潴留，胃潴留组的APACHE- Ⅱ评分较非胃潴留组高。

Abstract:

Objective To observe the effect of intra-abdominal pressure (IAP) on gastric retention in criticallyill patients through dynamic monitoring, to find the critical value of intra-abdominal pressure in patients with gastric retention, and observe the correlation between gastric retention and APACHE-II score. Methods Critically-ill patients in the ICU of Wenzhou Pelople’s Hospital were selected between August 2014 and November 2016 with indwelling catheter, nasogastric tube and given nasal feeding of enteral nurtritional suspension (TPF, 1 kcal/1 ml, 500 ml/bottle). No gastrointestinal motility drug nor long-time sedative drug was given during intra-abdominal pressure monitoring. Intra-abdominal pressure was detected by bladder manometer 4 times a day, twice 1 hour after feeding and twice 12 hours after feeding, the average value was recorded. Intra-gastric nutrient through indwelling nasogastric tube was fed with enteral nutrition micropump (37-40℃ ). On the first day, the infuse speed was 50 ml/h, and from the second day on (if unobstructed) the infusion proceeded at a speed of 50-100 ml/h, if obstructed, the speed was maintained at 50 ml/h. If gastric retention was observed, intra-abdominal pressure was instantly measured twice, the average value was recorded. On the next day after gastric retension, the patients were fed with warm water to observe the time of gastric patency. APACHE-II scores were assessed to all cases. Results The average value of intra-abdominal pressure was (9.8 ± 1.5) mmHg. The incidence of intra-abdominal hypertension was 64.7%. The gastric retention rate was 33.6 %. Compared to the non intra-abdominal hypertension group, the incidence of gastric retention was higher in the intra-abdominal hypertension group (P < 0.05). The average value of IAP in the patients with gastric retention was (17.4 ± 0.4) mmHg. The average APACHE-II score was (19.7 ± 3.6) in the gastric retention patients, and (12.0 ± 2.5) in the non-gastric retention patients, the former was significantly higher than the latter (P < 0.05). Conclusions The IAP in the critically-ill patients in ICU usual increases. When IAP increases to (17.4 ± 0.4) mmHg, the patients who are fed with TPF (1 kcal/1 ml, 500 ml/bottle) through nasal tube are prone to gastric retention. The patients with gastric retention have higher average APACHE-II score.