减少胃残余量监测频率对经鼻肠内营养患者影响的研究

doi:10.3761/j.issn.0254-1769.2024.05.010

摘要/Abstract

摘要：

目的探讨减少胃残余量监测频率对经鼻肠内营养患者喂养并发症及摄入热量的影响。方法采用方便抽样法，选取2020年10月—2023年1月在北京市某三级甲等医院内科ICU、呼吸ICU、急诊ICU住院并接受机械通气及经鼻胃管持续肠内营养的110例患者作为研究对象，采用随机数字表法，分为试验组和对照组，每组各55例。试验组在启动肠内营养后第12小时监测1次胃残余量，之后每天在相同的时间点监测1次，对照组每4 h监测1次胃残余量，两组均从启动肠内营养时开始，观察、记录至入住ICU第7天，比较两组的喂养并发症及入住ICU第7天摄入热量。结果试验组及对照组各52例完成研究。试验组在入住ICU 7 d内呕吐发生率及胃残余量最大值均略高于对照组，但差异无统计学意义（P>0.05），两组均未出现鼻胃管堵塞。入住ICU第7天试验组摄入热量高于对照组（Z=-2.107，P=0.035）、试验组摄入热量达标患者所占比例高于对照组（χ²=6.62，P=0.010），差异具有统计学意义。结论降低胃残余量监测频率为1次/d可在不增加喂养并发症发生率情况下，提高患者入住ICU第7天的摄入热量达标率。

关键词: 胃残余量监测, 肠内营养, 重症监护病房, 护理

Abstract:

Objective To evaluate the effect of reducing frequency of gastric residual volume monitoring on enteral feeding-related complication and caloric intake in ICU patients. Methods Patients who admitted to medical ICU，respiratory ICU and emergency ICU of a tertiary A teaching hospital in Beijing during October 2020 to January 2023 and undergoing mechanical ventilation and continuous enteral feeding via nasogastric tube in 24~48 hours were enrolled. According to the random number table method，they were divided into a control group and an intervention group，with 52 cases in each group. Gastric residual volume was monitored daily 12h after enteral nutrition initiation in the intervention group，and every 4 hours in the control group. The enteral feeding-related complication and caloric intake of the 2 groups were recorded after enteral nutrition initiated and until 7th day in ICU. Results 52 cases completed the study in each group respectively. During the first 7 days，the incidence of vomiting and the maximum of gastric residual volume in the experimental group were higher than those in the control group，with no statistically significant differences. No nasogastric tube occlusion was observed in any patients in either group. Compared to the control group，both the caloric intake of 7th day in ICU and the proportion of patients achieving calorie target on 7th day in ICU were significantly higher in the experimental group，with statistically significant differences. Conclusion Reducing the frequency of gastric residual volume monitoring to once a day could significantly increase caloric intake of patients without an increase in enteral feeding-related complication.

Key words: Gastric Residential Volume Monitoring, Enteral Nutrition, Intensive Care Units, Nursing Care

余昆容, 李凡, 侯青敏, 徐颖臻, 李小容, 马俊, 陈燕, 关玉霞. 减少胃残余量监测频率对经鼻肠内营养患者影响的研究[J]. 中华护理杂志, 2024, 59(5): 582-587.

YU Kunrong, LI Fan, HOU Qingmin, XU Yingzhen, LI Xiaorong, MA Jun, CHEN Yan, GUAN Yuxia. The effect of reducing frequency of gastric residual volume monitoring on enteral nutrition in ICU patients[J]. Chinese Journal of Nursing, 2024, 59(5): 582-587.

图/表 3

表1 两组一般资料的比较

Table 1 Comparison of general data between 2 groups

表2 两组喂养并发症及临床结局比较

Table 2 Comparison of feeding complications rate and clinical outcomebetween 2 groups

表3 两组入住ICU第7天肠内营养种类及摄入热量比较

Table 3 Comparison of enteral nutrition types and caloric intake on 7th day between 2 groups

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