腹腔内压监测在指导腹内高压肠内营养治疗中的应用

陈兴旺 姚志军 汪红杰

【摘要】 目的：探讨腹腔内压监测在指导腹内高压肠内营养治疗中的应用。方法：选取2016年12月-2018年12月本院重症患者80例，按照随机数字表法将其分为监测组和常规组，每组各40例。常规组给予常规肠内营养支持，监测组在此基础上给予腹内压监测。观察两组腹内压情况、血乳酸、白蛋白、APACHE-Ⅱ评分及不良事件。结果：治疗后，监测组腹内压、腹内高压发生率均低于常规组（P<0.05）;治疗后，监测组血乳酸、APACHE-Ⅱ评分均低于常规组，白蛋白水平均高于常规组，差异均有统计学意义（P<0.05）;治疗3 d后，监测组不良事件发生率为17.50%，低于常规组的45.00%（P<0.05）。结论：腹腔内压可作为危重症患者胃肠内营养的相关监测指标，并且能够进一步有效控制患者腹内高压，提高患者肠内营养效果，降低不良事件发生率，值得临床推广。

【关键词】 腹腔内压监测; 腹内高压; 肠内营养

【Abstract】 Objective：To discuss the application of intra-abdominal pressure monitoring in guiding enteral nutrition treatment of intra-abdominal hypertension.Method：A total of 80 patients with severe illness in our hospital from December 2016 to December 2018 were selected.According to the random number table method，they were divided into monitoring group and routine group，40 cases in each group.Routine group was given routine enteral nutrition support，and monitoring group was given intra-abdominal pressure monitoring on this basis.The intra-abdominal pressure，blood lactic acid，albumin，APACHE-Ⅱ score and adverse events of two groups were observed.Result：After treatment，the incidence of intra-abdominal pressure and intra-abdominal pressure in monitoring group were lower than those of routine group（P<0.05）.After treatment，the blood lactate and APACHE-Ⅱ scores of monitoring group were lower than those of routine group，and the albumin level was higher than that of routine group，the differences were statistically significant（P<0.05）.After 3 days of treatment，the incidence of adverse events in monitoring group was 17.50%，which was lower than 45.00% of routine group（P<0.05）.Conclusion：Intra-abdominal pressure can be used as a monitoring index of gastrointestinal nutrition in critically ill patients，and can further effectively control the intra-abdominal hypertension，improve the effect of enteral nutrition，and reduce the incidence of adverse events，which is worthy of clinical promotion.

【Key words】 Intra-abdominal pressure monitoring; Intra-abdominal hypertension; Enteral nutrition

First-authors address：Baoan District Shajing Peoples Hospital，Shenzhen 518104，China

doi：10.3969/j.issn.1674-4985.2019.16.031

重癥患者是临床较为特殊的群体，其病情危急，并且病程具有自限性，多数重症患者会出现胃肠功能障碍，同时伴随着腹内高压症状，导致患者机体代谢明显增高，可严重影响患者的机体营养状况[1-2]。目前，肠内营养是重症患者重要的营养补充方式，但由于危重症患者病情的复杂性，且腹内压与胃肠功能密切相关，盲目对患者进行肠内营养支持可能会加剧病情恶化[3]。而有研究显示，腹腔内压监测能够及时、有效了解患者的腹内压水平，继而有利于医生对患者进行肠内营养支持，但其治疗效果还有待进一步研究[4-5]。对此，本研究通过给予重症患者腹腔内压监测，探讨其在指导腹内高压肠内营养治疗中的应用效果，现报道如下。

1 资料与方法

1.1 一般资料 选取2016年12月-2018年12月本院重症患者80例。纳入标准：年龄>18岁;患者发病72 h内入院;空肠营养前患者未见腹痛、腹胀、腹泻等临床症状[4]。排除标准：妊娠或哺乳人群;近期有膀胱手术史;有心、肝、肾等严重性疾病;患者中途死亡。按……