护士主导的床旁超声在ICU肠内营养患者腹胀管理中的应用

doi:10.3761/j.issn.0254-1769.2024.17.011

摘要/Abstract

摘要：

目的探讨护士主导的床旁超声在ICU肠内营养患者腹胀中的应用。方法采用目的抽样法，选取2022年1月—12月入住合肥市某三级甲等综合医院ICU实施肠内营养的腹胀患者108例，根据随机数字表法，分为试验组和对照组，试验组使用床旁超声对腹胀患者实施胃、肠、腹腔的评估，并根据评估结果实施针对性的处理措施；对照组根据腹部的视、触、叩、听及传统的注射器回抽法判断胃残余量，给予相应处理措施。比较两组第1、3、5天腹内压、腹围、喂养达标率、喂养中断率及ICU入住时间和机械通气时间的差异。结果 11例因转科、自动出院、死亡等退出研究，最终纳入97例，试验组51例，对照组46例。重复测量方差分析显示，两组腹内压、腹围均存在时间与组间的交互效应（F_交互=41.724，P_交互<0.001；F_交互=17.762，P_交互<0.001）。广义估计方程显示，两组喂养达标率、喂养中断率仅存在组间效应（Wald χ²_组间=18.033，P_组间<0.001；Wald χ²_组间=6.567，P_组间<0.001）。简单效应分析显示，干预第3、5天，试验组腹内压、喂养中断率低于对照组（P<0.05）；干预第5天，试验组腹围小于对照组，喂养达标率高于对照组（P<0.05）。干预后，试验组机械通气时间短于对照组（P<0.05），两组ICU入住时间比较，差异无统计学意义（P=0.095）。结论护士主导的床旁超声在ICU肠内营养患者腹胀管理中的应用具有可行性、科学性，有助于降低腹内压，缩短机械通气时间，降低喂养中断，提高喂养达标率。

关键词: 护士, 超声, 腹胀, 肠内营养, 重症监护病房

Abstract:

Objective To explore the application of nurse-performed point-of-care ultrasound in abdominal distension of ICU patients with enteral nutrition. Methods Purposive sampling method was used to select 108 patients with enteral nutrition abdominal distension admitted to the ICU of a tertiary A general hospital in Hefei City from January to December 2022，and they were divided into an experimental group and a control group according to random number table method. The experimental group used bedside ultrasound to evaluate the stomach，intestine and abdominal cavity of patients with abdominal distension，and implemented targeted treatment measures according to the evaluation results. The control group was given corresponding treatment measures according to the abdominal sight，touch，tapping，listening and traditional syringe withdrawal method. Intra-abdominal pressure，abdominal circumference，feeding compliance rate and feeding interruption rate，ICU stay time and mechanical ventilation time were compared at the 1st，3rd and 5th day. Results 11 cases dropped out of the study due to transfer，automatic discharge，death，etc.，and 97 cases were included 51 cases in the experimental group and 46 cases in the control group. Repeated measurement ANOVA showed that intra-abdominal pressure and abdominal circumference time in the 2 groups had interaction with each other（F=41.724，P<0.001；F=17.762，P<0.001）. Generalised estimating equations showed that there was only a between-group effect for the rates of feeding compliance and feeding disruption in 2 groups（Wald χ²=18.033，P<0.001；Wald χ²=6.567，P<0.001）. Simple effect analysis showed that on the 3rd and 5th day after intervention. The experimental group had lower abdominal depression and the feeding interruption rate was lower than the control group（P<0.05）. On the 5th day after interven-tion，the abdominal circumference of the experimental group was lower than that of the control group，the feeding compliance rate was higher than that of control group（P<0.05）. After intervention，in the experimental group，the mechanical ventilation time was shorter than that of the control group（P<0.05）. There was no significant difference in ICU stay time between the 2 groups（P=0.095）. Conclusion The application of nurse-performed point-of-care ultrasound in the management of abdominal distension in patients with enteral nutrition in ICU is feasible and scientific，which is helpful for the management of patients with enteral nutrition abdominal distension in ICU，reducing internal abdominal pressure，shortening mechanical ventilation time，and avoiding the occurrence of feeding intolerance.

Key words: Nurse, Ultrasound, Abdominal Distension, Enteral Nutrition, Intensive Care Unit

倪秀梅, 胡少华, 韩江英, 付红, 蔡月红, 赵利灿, 王继海, 詹雪梅. 护士主导的床旁超声在ICU肠内营养患者腹胀管理中的应用[J]. 中华护理杂志, 2024, 59(17): 2123-2129.

NI Xiumei, HU Shaohua, HAN Jiangying, FU Hong, CAI Yuehong, ZHAO Lican, WANG Jihai, ZHAN Xuemei. The application of nurse-performed point-of-care ultrasound in the management of abdominal distension in patients with enteral nutrition in ICU[J]. Chinese Journal of Nursing, 2024, 59(17): 2123-2129.

图/表 6

图1 腹胀患者床旁超声图像

Figure 1 Bedside ultrasound images of patients with abdominal distension

表1 两组一般资料的比较（n=97）

Table 1 Baseline information of participants in 2 groups（n=97）

表2 试验组胃、肠及腹腔超声评估结果[n=51，例（百分比，%）]

Table 2 Results of gastric，intestinal and abdominal ultrasound evaluation in the experimental group[n=51，cases（percentage，%）]

表3 两组干预前后腹内压及腹围比较（mmHg，cm，$\bar{x}\pm s$）

Table 3 Comparison of intra-abdominal pressure and abdominal circumference between 2 groups（mmHg，cm，$\bar{x}\pm s$）

表4 两组干预后喂养达标率及中断率比较[例（百分比，%）]

Table 4 Comparison of the rate of feeding compliance and interruption after intervention between 2 groups [cases（percentage，%）]

表5 两组ICU入住时间、机械通气时间比较（d，$\bar{x}\pm s$）

Table 5 Comparison of the length of ICU stay and the length of mechanical ventilation between 2 groups（d，$\bar{x}\pm s$）

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