床旁超声测量胃窦横截面积对重症患者喂养不耐受的预测价值

邹同娟; 冉启芳; 尹万红; 许媛; 何伟; 杨毅; 欧阳彬; 朱然; 康焰

床旁超声测量胃窦横截面积对重症患者喂养不耐受的预测价值

The Value of Gastric Antrum Cross-sectional Area Mearsured by Bedside Ultrasound Predicted Feeding Intolerance in Critically Ill Patients

摘要

摘要:
目的探讨床旁超声测量胃窦横截面积(CSA)预测重症患者喂养不耐受的可行性及价值。
方法回顾分析多中心前瞻性观察性研究数据库，纳入2018年2~12月期间国内5家三甲医院ICU经鼻胃管行肠内营养持续3 d以上的患者。统计分析仰卧位及右侧卧位胃窦CSA与重症患者喂养不耐受的相关性，绘制ROC曲线，获取最佳截断值。
结果共纳入150例患者，平均年龄为(58.63±16.45)岁，平均急性生理与慢性健康(APACHE Ⅱ)评分为(17.43±6.99)分。肠内营养3 d喂养不耐受发生率为28.0%。多因素分析示，第二天右侧卧位胃窦CSA是第二天发生喂养不耐受的独立危险因素(P=0.033)，第三天右侧卧位胃窦CSA是第三天发生喂养不耐受的独立危险因素(P=0.016)。第三天胃窦右侧卧位CSA≥7.092 cm²的患者较 < 7.092 cm²的患者的喂养不耐受发生率明显更高(P=0.001)。
结论床旁超声测量喂养后胃窦横截面积可以预测重症患者当日肠内营养喂养不耐受发生。当第三天右侧卧位胃窦CSA≥7.092 cm²时，发生肠内营养喂养不耐受的概率率明显升高。

Abstract:
Objective To explore the feasibility and effectiveness of gastric antrum cross-sectional area (CSA) mearsured by bedside ultrasound for predicting early feeding intolerance (FI) in critically ill patients.
Methods The data were extracted from a multicenter prospective observation study between February 2018 to December 2018. A bivariate logistic regression model was established to identify the correlation between the gastric antrum cross-sectional area (CSA) and the feeding intolerance (FI). Draw the ROC curve to get the best cut-off value.
Results This study comprises 150 patients. The mean age was (58.63±16.45) yr., the average APACHE Ⅱ score was 17.43±6.99. The incidence of FI for three days (72 h-FI%) was 28.0%. The multivariate analysis demonstrated that the Day 2 CSA-right lateral decubitus (RLD) was an independent risk factor for FI-day 2 (P=0.033), Day 3 CSA -RLD was an independent risk factor for FI-day 3 (P=0.016). Patients with day 3 CSA-RLD ≥7.092 cm² had significantly higher rates of FI (P=0.001).
Conclusion Gastric antrum cross-sectional area measured by ultrasound can predict feeding intolerance during early enteral nutrition. When the Day 3 CSA-RLD is greater than 7.092 cm², the incidence of feeding intolerance is significantly increased.

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