中国现代医学杂志2018，Vol.28Issue(11)：65-67,3.DOI:10.3969/j.issn.1005-8982.2018.011.012
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
Abstract
Objective To observe the effect of intra-abdominal pressure (IAP) on gastric retention in critically-ill 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.关键词
腹腔内压/胃肠内营养/胃潴留/急性生理学与慢性健康状况评分系统ⅡKey words
intra-abdominal pressure/enteral nutrition/gastric retention/APACHE-Ⅱ score分类
医药卫生引用本文复制引用
杨宝华,余颖聪,徐秋胜,金献冠,陈新国,陈玲珑..腹内压对胃潴留的影响及其临界值观察[J].中国现代医学杂志,2018,28(11):65-67,3.基金项目
浙江省温州市科学技术局科技计划公益类项目(NO:Y20140251) （NO:Y20140251）
