本文關(guān)鍵詞： 腸內(nèi)營養(yǎng) 誤吸 折光儀 胃殘余量 胃殘余濃度　出處：《山西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:對NICU腸內(nèi)營養(yǎng)患者誤吸與胃殘余(胃殘余量、胃殘余濃度)的相關(guān)性進行研究并探討影響胃殘余濃度的因素。方法:收集山西醫(yī)科大學第一臨床醫(yī)學院2016年6月至2016年12月入住NICU、年齡≥18歲,且經(jīng)鼻飼飲食給予腸內(nèi)營養(yǎng)≥4天的患者,排除既往胃食管反流病史、發(fā)病前有嚴重肺部疾病、消化道出血、消化道先天畸形的患者,排除因各種原因不能持續(xù)鼻飼進食的患者。所有病人鼻飼喂養(yǎng)時床頭抬高30°-45°,使用同一型號鼻胃管、鼻腸管�；颊弑秋暊I養(yǎng)液有腸內(nèi)營養(yǎng)乳劑TPF-D(瑞代),腸內(nèi)營養(yǎng)乳劑TPF-T(瑞能),腸內(nèi)營養(yǎng)乳劑TP-HE(瑞高)以及腸內(nèi)營養(yǎng)混懸液TPF1.5(能全力)�；颊哌M行鼻飼腸內(nèi)營養(yǎng)乳劑后的3天時間內(nèi)分別于每天10:00-22:00之間每間隔4小時回抽胃殘余,利用手持折光儀測定胃內(nèi)容物的折射率并計算胃殘余量和胃殘余濃度,同時由專業(yè)護士收集痰標本,對痰液標本采用ELISA法進行胃蛋白酶檢測,根據(jù)胃蛋白酶含量檢測結(jié)果將患者分為頻繁誤吸組和非頻繁誤吸組,按照胃殘余濃度分為低、中、高胃殘余濃度組,進而分析比較各組之間胃殘余濃度、胃殘余量等有無統(tǒng)計學差異,尋找影響胃殘余濃度的因素。結(jié)果:1.納入NICU患者30例,其中男22例,女8例,年齡36-83歲,平均年齡59.83±14.82歲,GCS評分3-15分,平均8.10±3.01,APACHEⅡ評分14-38分,平均24.93±6.12,監(jiān)測胃殘余量0-310ml,平均(23.02±27.78)ml,胃殘余濃度0-100%,平均(50.28±28.13)%。納入患者中,腦血管病19例,非腦血管病11例,其中腦血管病患者NIHSS評分9-43分,平均24.79±9.07。所有患者中氣管插管5例,氣管切開2例,呼吸機輔助呼吸4例。共留取痰標本174個。2.以胃蛋白酶含量≥6.5ng/m L為陽性,樣本陽性率25%為頻繁誤吸組,25%為非頻繁誤吸組,頻繁誤吸組共16人,非頻繁誤吸組14人,頻繁誤吸組GCS評分為7.06±2.79,非頻繁誤吸組GCS評分為9.29±2.89,兩組之間差別具有統(tǒng)計學意義(P=0.041);兩組間年齡、性別及鼻飼方式等差別無統(tǒng)計學意義。3.頻繁誤吸組GRV均數(shù)為(27.30±29.75)ml,非頻繁誤吸組為(18.13±25.55)ml,兩組之間差別無統(tǒng)計學意義(P=0.376)。頻繁誤吸組與非頻繁誤吸組相比,兩組間出現(xiàn)GRV增高(≥50、100、150ml)的次數(shù)差別亦無統(tǒng)計學差異。4.頻繁誤吸組胃殘余濃度高于非頻繁誤吸組,分別為(59.70±28.11)%、(39.53±24.90)%(P=0.048)。對比頻繁誤吸組與非頻繁誤吸組中患者不同胃殘余濃度出現(xiàn)的次數(shù),當胃殘余濃度至少1次出現(xiàn)≥60%、70%、80%時,兩組之間差別無統(tǒng)計學意義。然而,當出現(xiàn)至少3次胃殘余濃度≥60%、70%時,更易出現(xiàn)頻繁誤吸;頻繁誤吸組出現(xiàn)至少2次胃殘余濃度≥80%及至少1次≥90%的例數(shù)較非頻繁誤吸組更多。5.按照胃殘余濃度不同分為30%、30%-60%以及60%組(即低胃殘余濃度、中胃殘余濃度和高胃殘余濃度組)。NICU患者低、中、高胃殘余濃度組相比,GCS評分及腦血管病患者NIHHS評分差別具有統(tǒng)計學意義;不同鼻飼方式在這三組之間差別同樣具有統(tǒng)計學意義。結(jié)論:對NICU留置鼻飼飲食的患者,監(jiān)測胃殘余量并不能用于評估誤吸發(fā)生的風險,胃殘余量較低時仍存在有誤吸頻繁發(fā)生。誤吸更常發(fā)生于胃殘余濃度較高的患者,監(jiān)測胃殘余濃度及胃殘余濃度增高的次數(shù)可以評估誤吸頻繁發(fā)生的風險。胃殘余濃度受意識障礙程度及鼻飼方式的影響,留置鼻腸管可以明顯降低胃殘余濃度。
[Abstract]:Objective: the NICU enteral nutrition in patients with gastric aspiration and residual (gastric residual gastric residual concentration) to study the relationship between gastric residual concentration and explore the influencing factors. Methods: We collected the first clinical medical college of Shanxi Medical University from June 2016 to December 2016 in NICU, 18 years of age or older, and by nasal feeding with enteral nutrition is more than 4 day patients, exclude the previous history of gastroesophageal reflux, a serious lung disease, gastrointestinal bleeding, digestive tract malformation were excluded for various reasons can not continue nasal feeding patients. All patients with nasal feeding feeding head elevation 30 -45 degrees, use the same type of nasogastric tube, nasal tube. Patients with nasal feeding nutrient solution (ill), Enteral Nutritional Emulsion TPF-D Enteral Nutritional Emulsion TPF-T (Supportan), Enteral Nutritional Emulsion TP-HE (Philippines) and Enteral Nutritional Suspension TPF1.5 (full power). Patients with nasogastric enteral nutrition After the emulsion 3 days respectively in every 10:00-22:00 between every 4 hours to draw the gastric residual gastric contents determination of refractive index using the handheld refractometer and calculate the residual rate of gastric and gastric residual concentration, at the same time by professional nurses to collect the sputum samples of sputum samples by ELISA method for the detection of pepsin, according to the test results pepsin contents were divided into frequent aspiration group and the non frequent aspiration group, in accordance with the gastric residual concentration is divided into low, high concentration group, gastric residual, and then compared between the residual concentration of stomach, gastric residual volume have no statistical difference, find the influence factors of gastric residual concentration. Results: 1. in 30 NICU patients, male 22 cases, female 8 cases, age 36-83 years, mean age 59.83 + 14.82 years old, GCS score of 3-15 points, an average of 8.10 + 3.01, APACHE score of 14-38 points, an average of 24.93 + 6.12, monitoring residual gastric volume 0-310ml, average (23.02. 27.78)ml,鑳冩畫浣欐祿搴，

本文編號：1474193