| Objective Nutritional support is an integral part of treatment in intensive care units(ICU).Enteral nutrition(EN),especially early enteral nutrition(EEN),can help the gastrointestinal tract resume normal function and prevent the occurrence of enterogenous infection,thus improving the autoimmune function and further avoiding the occurrence of intestinal failure.In addition,ICU patients are affected by diseases,analgesia and sedation,mechanical ventilation,long-term bed rest and other factors,and the incidence of gastrointestinal motility disorders is very high.Therefore,it is particularly important to accurately evaluate the status of patients' gastrointestinal function,formulate a reasonable EEN scheme,and then guide the implementation of EN.In this study,Gastric antrum section was measured by ultrasound,so as to calculate Gastric Residual Volume(GRV).Comparing with traditional extraction monitoring GRV,EEN was guided to implement,so as to explore its clinical significance.Methods Sixty patients admitted to our department from January 2018 to June 2019 were selected,and all patients were routinely treated after admission,including indwelling nasogastric tube.Enteral nutrition support begins within 48 hours of admission to icu.Exclusion criteria :(1)age <18;(2)there are early EN contraindications,such as gastrointestinal obstruction,tumor and bleeding;(3)patients with severe abdominal distension or obesity;(4)do not cooperate with the data collector during the study.The 60 patients were randomly divided into the experimental group(ultrasound monitoring gastric residual volume)and the control group(gastric fluid extraction monitoring gastric residual volume),30 patients in each group,all of whom received EEN support and intermittent feeding.Patients in both groups were uniformly pumped by enteral nutrition pump and the speed was adjusted.The experimental group:By bedside ultrasound monitoring gastric residual volume,the use of bedside ultrasound diagnostic instrument,choose gastric antrum single aspect,the ultrasonic probe in patients below xiphoid process,perpendicular to the Angle of the abdomen,the ultrasound imaging of gastric antrum size,by measuring the distal transverse diameter and diameter to calculate the gastric antrum area before and after,again through gastric antrum area and age of the contrasttable gastric residual volume,such as GRV 250 ml or less,the monitoring once a day(daily monitoring time around 8:30 in the morning),the patient supine(30 °,45 °)of the head of a bed,when GRV > 250 ml,slow down the speed of enteral nutrition or suspension of enteral nutrition,Gastric residual volume was detected after 6 hours.If GRV?250ml,the original feeding rate was maintained.Control group: GRV was measured by gastric juice withdrawal every 4 hours.If GRV> was 250 ml,the enteral nutrition speed was slowed or suspended;if GRV?250ml,the original feeding speed was maintained.Records of the patient's age,gender,disease and APPCHE II score of patients,also record some clinical observation indexes such as EN complications(vomiting,diarrhea,abdominal distention,etc.),infection complications(blood infection,catheter related infections and ventilator associated pneumonia(VAP),etc.),including relevant prognostic indicators,mechanical ventilation time and ICU admission time achieve feeding time(25 kcal/kg/d).Results There was no statistically significant difference between the experimental group and the control group in terms of age,gender,APACHEII score,hypertension,diabetes,cerebral infarction,severe pneumonia and other general data(P >,0.05).In the control group,one or more EN complications occurred in 50.0% of the patients,and the experimental group was only 23.3%,which was significantly lower than the control group.The difference was statistically significant(P < 0.05),but no difference was found in the subgroup(P > 0.05).In terms of the overall incidence of infection complications,the experimental group(20.0%)was lower than the control group(36.6%),and the difference was statistically significant(P < 0.05),while the difference between the subgroups was not statistically significant(P > 0.05).In terms of ICU stay time,target feeding time and mechanical ventilation time,the experimental group had a shorter time,and the difference was statistically significant(P <0.05);The incidence of gastrointestinal bleeding in the control group was higher than that in the experimental group,and the difference was not statistically significant(P >,0.05).The case fatality rate of the experimental group was lower than that of the control group,and the difference was not statistically significant(P > 0.05).Conclusions Ultrasound monitoring of GRV through the single section of gastric antrum can provide more objective guidance for EEN's safe and effective implementation.Compared with conventional methods,GRV monitoring can reduce the incidence of EN complications and infectious complications,shorten the length of ICU stay and mechanical ventilation,and achieve target feeding faster,thus benefiting patients.The application of early enteral nutritionin critical patients was guided by bedside ultrasound monitoring gastric residual volume. |
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