摘要
目的:探讨急性胃肠损伤(acute gastrointestinal injury,AGI)分级标准对危重症患者胃肠功能障碍评估价值及其在早期肠内营养(enteral nutrition,EN)支持中的应用效果.方法:选取2013-01/2014-01河南省中医院重症监护病房(intensive care unit,ICU)收治的78例胃肠功能障碍患者为研究对象,患者入住ICU后12-24 h内行EN治疗.根据AGI分级标准将患者分为Ⅰ级35例,Ⅱ级22例,Ⅲ级12例,Ⅳ级9例,并按AGI指南对患者实施对应治疗,观察EN实施前后营养状态、病情程度及EN摄入量达标率、胃肠黏膜功能的变化,并分析AGI分级与EN喂养率及热量达标率的关系.结果:4组患者入ICU时急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation systemⅡ,APACHEⅡ)、血清白蛋白(serum albumin,ALB)、氮平衡(nitrogen balance,NB)、总蛋白(total protein,TP)、胃黏膜pH值、乳酸值、胃黏膜二氧化碳分压(PgCO2)水平无统计学差异(P>0.05),治疗7 d后,Ⅰ-Ⅲ级患者APACHEⅡ评分、乳酸值、PgCO2均显著下降(P<0.05),ALB、NB、TP、pH值水平显著升高(P<0.05).Ⅳ级患者入住ICU 7 d时,APACHEⅡ评分、乳酸值、PgCO2显著高于Ⅰ-Ⅲ级患者(P<0.05),而NB、TP、pH值水平均低于Ⅰ-Ⅲ级患者(P<0.05),各组间ALB水平差异无统计学意义(P>0.05).Ⅰ-Ⅳ级患者24 h喂养率分别为91.43%、68.18%、50.00%、0.00%,48 h喂养率分别为100.00%、81.82%、58.33%、0.00%,7 d热量达标率分别为100.00%、81.82%、66.67%、22.22%.相关分析显示,AGI分级与24 h喂养率、48 h喂养率及72 h营养达标率呈负相关(均P<0.05).结论:AGI分级与EN治疗效果具有良好的相关性,可作为危重症患者胃肠道功能的评价指标.
AIM： To investigate the value of acute gastrointestinal injury（AGI） grading system in assessing gastrointestinal dysfunction in critically ill patients and to assess its application in early enteral nutrition（EN）. METHODS： Seventy-eight patients with gastrointestinal dysfunction admitted to intensive care unit（ICU） from January 2013 to January 2014 were divided into different groups using the AGI grading system： gradeⅠ（35 cases）, grade Ⅱ（22 cases）, grade Ⅲ（12 cases）, and grade Ⅳ（9 cases）. The patients were given appropriate treatment based on the AGI guideline. The nutritional status before and after EN implementa-tion, severity, rate of adequate intake, changes in the function of the gastrointestinal mucosa were compared between the two groups. The relationship between AGI grading and EN feeding rate and rate of adequate calories was also analyzed. RESULTS： The levels of APACHE Ⅱ score, serum albumin（ALB）, nitrogen balance（NB）, total protein（TP）, gastric pH, lactate, and PgCO2 showed no significant differences among the four groups before treatment（P 〉0.05）; after 7 d of treatment, the APACHE Ⅱ score, lactate, and PgCO2 significantly decreased（P〈0.05）, and the levels of ALB, NB, TP, and pH value significantly increased in grades Ⅰ-Ⅲ groups（P〉 0.05）. The APACHE Ⅱ score, lactate, and PgCO2 were significantly higher（P〈 0.05）, and the values of NB, TP, and pH before treatment were significantly lower in grade Ⅳ group than in grades Ⅰ-Ⅲ groups（P〈0.05）, although the level of ALB showed no significant difference among the four groups（P〉0.05）. The 4-h feeding rates in grades Ⅰ-Ⅳ groups were 91.43%, 68.18%, 50.00%, and 0.00%, respectively, and the 48-h feeding rates were 100.00%, 81.82%, 58.33%, and 0.00%. The 7-d rate of adequate calories in grades Ⅰ-Ⅳ groups were 100.00%, 81.82%, 66.67% and 22.22%, respectively. CONCLUSION： AGI grading has a good correlation with EN treatment and can be used for gastrointestinal function evaluation in critically ill patients.
出处
《世界华人消化杂志》
CAS
北大核心
2014年第30期4668-4673,共6页
World Chinese Journal of Digestology
关键词
急性胃肠损伤分级
危重症患者
胃肠功能障碍
肠内营养
Acute gastrointestinal injury grading
Critically ill patients
Gastrointestinal dysfunction
Enteral nutrition
