本文選題：機(jī)械通氣患者　切入點(diǎn)：腸內(nèi)營(yíng)養(yǎng)　出處：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文

【摘要】：研究背景:機(jī)械通氣患者的腸內(nèi)營(yíng)養(yǎng)喂養(yǎng)不耐受發(fā)生率高,胃殘余量作為喂養(yǎng)不耐受的預(yù)測(cè)指標(biāo)其臨界值不統(tǒng)一。探究一種新的客觀、準(zhǔn)確預(yù)測(cè)喂養(yǎng)不耐受的指標(biāo)成為臨床研究的重點(diǎn)�；诟箖�(nèi)壓與胃腸道功能相互影響的病理生理機(jī)制,腹內(nèi)壓與腸內(nèi)營(yíng)養(yǎng)喂養(yǎng)不耐受的發(fā)生可能存在相關(guān)性。本研究旨在探究機(jī)械通氣患者腹內(nèi)壓與喂養(yǎng)不耐受的相關(guān)性,以期為預(yù)測(cè)喂養(yǎng)不耐受的發(fā)生,及早采取有效措施,幫助患者腸內(nèi)營(yíng)養(yǎng)的順利進(jìn)行提供有價(jià)值的科學(xué)依據(jù)。研究目的:探究機(jī)械通氣患者腹內(nèi)壓與腸內(nèi)營(yíng)養(yǎng)喂養(yǎng)不耐受的相關(guān)性;探究機(jī)械通氣患者腹內(nèi)壓對(duì)腸內(nèi)營(yíng)養(yǎng)喂養(yǎng)不耐受性的預(yù)測(cè)價(jià)值。研究方法:本研究為描述性研究,便利抽取2016年5月～2017年1月,對(duì)北京地區(qū)某三甲醫(yī)院重癥監(jiān)護(hù)病房進(jìn)行治療的110例氣管插管的機(jī)械通氣患者進(jìn)行調(diào)查,于患者腸內(nèi)營(yíng)養(yǎng)前及腸內(nèi)營(yíng)養(yǎng)后的前3天采用經(jīng)尿道膀胱壓力測(cè)量患者的腹內(nèi)壓,并記錄患者腸內(nèi)營(yíng)養(yǎng)過(guò)程中喂養(yǎng)不耐受(腸鳴音減弱或消失、腹瀉、胃殘余量、便秘、嘔吐/反流、胃腸道出血)的發(fā)生情況。采用偏相關(guān)分析腹內(nèi)壓與喂養(yǎng)不耐受的相關(guān)性,采用ROC曲線確定腹內(nèi)壓預(yù)測(cè)患者喂養(yǎng)不耐受發(fā)生的臨界值。研究結(jié)果:110例機(jī)械通氣患者腹內(nèi)壓的基線水平和腸內(nèi)營(yíng)養(yǎng)前3天腹內(nèi)壓的水平分別為8.6±3.3mmHg和10.8±4.2mmHg,兩者之間有統(tǒng)計(jì)學(xué)差異(P0.01)�；颊呶桂B(yǎng)不耐受的發(fā)生率為73.6%,其中最主要的表現(xiàn)為腸鳴音減弱或消失(53.6%)和腹瀉(48.2%)。相關(guān)分析結(jié)果顯示腹內(nèi)壓與喂養(yǎng)不耐受呈顯著性正相關(guān)(P0.01)�；�與腸內(nèi)營(yíng)養(yǎng)前3天的腹內(nèi)壓預(yù)測(cè)患者喂養(yǎng)不耐受的ROC曲線下的AUC依次為0.81(95%CI:0.73～0.89)和0.86(95%CI:0.79～0.93),其預(yù)測(cè)喂養(yǎng)不耐受發(fā)生最佳臨界值分別為9mmHg和11mmHg。研究結(jié)論:氣管插管的機(jī)械通氣患者,其腹內(nèi)壓與早期腸內(nèi)營(yíng)養(yǎng)喂養(yǎng)不耐受的發(fā)生呈顯著性正相關(guān),當(dāng)腹內(nèi)壓基線水平≥9mmHg及早期腸內(nèi)營(yíng)養(yǎng)前3天腹內(nèi)壓水平≥11mmHg時(shí),應(yīng)警惕患者喂養(yǎng)不耐受的發(fā)生。
[Abstract]:Background: the incidence of enteral feeding intolerance in patients with mechanical ventilation is high and the critical value of gastric remnant as a predictor of feeding intolerance is not uniform.To explore a new objective and accurate predictor of feeding intolerance has become the focus of clinical research.Based on the pathophysiological mechanism of the interaction between intra-abdominal pressure and gastrointestinal function, there may be a correlation between intra-abdominal pressure and enteral feeding intolerance.The purpose of this study was to explore the relationship between intra-abdominal pressure and feeding intolerance in patients with mechanical ventilation, so as to provide a valuable scientific basis for predicting the occurrence of feeding intolerance and taking effective measures as early as possible to help patients with successful enteral nutrition.Objective: to explore the relationship between intra-abdominal pressure and enteral feeding intolerance in patients with mechanical ventilation, and to explore the predictive value of intra-abdominal pressure in patients with mechanical ventilation.Methods: for descriptive study, 110 cases of mechanical ventilation with tracheal intubation were selected from May 2016 to January 2017 in an intensive care unit of a third Class A hospital in Beijing area.The abdominal pressure was measured by transurethral bladder pressure 3 days before and 3 days after enteral nutrition. The feeding intolerance was recorded during enteral nutrition (decreased or disappeared of bowel tone, diarrhea, gastric remnant, constipation).Vomiting / reflux, gastrointestinal bleeding).Partial correlation analysis was used to analyze the correlation between intra-abdominal pressure and feeding intolerance, and ROC curve was used to determine the critical value of intra-abdominal pressure in predicting the occurrence of feeding intolerance in patients.Results the baseline level of intra-abdominal pressure and the level of intra-abdominal pressure 3 days before enteral nutrition were 8.6 鹵3.3mmHg and 10.8 鹵4.2 mmHg, respectively. There was a significant difference between them (P 0.01).The incidence of feeding intolerance in the patients was 73.6, the main manifestations of which were reduced or disappeared bowel sounds (53.6%) and diarrhea (48.2%).The results of correlation analysis showed that there was a significant positive correlation between intra-abdominal pressure and feeding intolerance (P 0.01).The AUC under the ROC curve of baseline and enteral nutrition for predicting the feeding intolerance of patients was 0.81g 95 CI: 0.73 0.89) and 0.8695 CI: 0.790.790.93, respectively. The best critical values for predicting the incidence of feeding intolerance were 9mmHg and 11mm Hg, respectively.Patients should be on guard against the occurrence of feeding intolerance.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R472.2

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