[1]陈蓓蓓,谢 琴,徐相勤,等.重症机械通气病人超声监测的肠系膜上动脉血流速变化预测肠内营养不耐受的临床研究[J].肠外与肠内营养杂志,2024,(03):154-161166.[doi:DOI : 10.16151/j.1007-810x.2024.03.005]
　CHEN Bei-bei,XIE Qin,XU Xiang-qin,et al.Changes in superior mesenteric artery blood flow velocity monitored byultrasound can predict enteral nutrition intolerance in mechanicallyventilated critical ill patients[J].PARENTERAL & ENTERAL NUTRITION,2024,(03):154-161166.[doi:DOI : 10.16151/j.1007-810x.2024.03.005]
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重症机械通气病人超声监测的肠系膜上动脉血流速变化预测肠内营养不耐受的临床研究()
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2024年03期
页码:
154-161166
栏目:
论著
出版日期:
2024-06-10

文章信息/Info

Title:
Changes in superior mesenteric artery blood flow velocity monitored byultrasound can predict enteral nutrition intolerance in mechanicallyventilated critical ill patients
作者:
陈蓓蓓1; 谢 琴1; 徐相勤 1; 马宇敏2; 刘肇修3
江苏省南通市第二人民医院，1.重症医学科；2.内分泌科，江苏南通226000；3.江苏省南通大学附属医院消化内科，江苏南通226000
Author(s):
CHEN Bei-bei1;  XIE Qin1;  XU Xiang-qin1;  MA Yu-min2;  LIU Zhao-xiu3
1. Intensive Care Department；2. Department of Endocrinology, the Second People’s Hospital ofNantong , Jiangsu Province, Nantong 226000, Jiangsu, China；3. Department of Gastroenterology,Affiliated Hospital of Nantong University , Jiangsu Province, Nantong 226000, Jiangsu, China
关键词:
肠内营养不耐受 ; 超声监测 ; 肠系膜动脉血流 ; 影响因素 ; 肠道屏障
Keywords:
Feeding intolerance;  Ultrasonography;  Mesenteric artery blood flow;  Enteral nutrition
分类号:
R574.4
DOI:
DOI : 10.16151/j.1007-810x.2024.03.005
文献标志码:
A
摘要:
目的：探讨机械通气病人超声监测肠系膜上动脉（SMA）血流速变化对肠内营养不耐受（FI）的影响及其预测效能。 方法：回顾性纳入南通市第二人民医院重症医学科2022年2月至2023年2月期间收治的108例机械通气病人的临床资料，分析肠内营养开始的第1、3、7天（D1、D3、D7）SMA血流参数及肠内营养耐受情况。研究肠内营养不耐受组和耐受组、不耐受组各亚组（轻、中、重度）病人SMA血流速参数差异；评估SMA血流参数对FI的预测价值，探索FI的风险因素，初步探究SMA血流参数与肠道屏障功能的关系。 结果：D1、D3及D7耐受组病人 SMA 血流速参数收缩期峰值速度(PSV)及舒张末期速度（EDV）均高于不耐受组，差异均有统计学意义（P <0.05）；亚组分析显示，D7 随着不耐受程度逐步加重，PSV 逐渐下降；D1、D3、D7 EDV 随着不耐受程度逐渐加重，EDV逐渐下降，差异均有统计学意义（P < 0.05）；D1、D3、D7病人PSV 及EDV预测FI的AUC分别为0.752（95%CI：0.660 ~ 0.830）及 0.773（95%CI：0.682 ~ 0.848）、0.774（95%CI：0.683 ~ 0.849）及 0.796（95%CI：0.708 ~ 0.868）、0.743（95%CI：0.650 ~ 0.822）及 0.713（95%CI：0.618 ~ 0.796）；D3病人PSV、去甲肾上腺素使用、血磷水平是FI的独立预后因素；肠内营养不耐受病人PSV、EDV与二胺氧化酶均呈负相关（PSV：r = -0.857，P < 0.001；EDV：r = -0.795，P <0.001）；PSV与脂多糖内毒素呈正相关（r = 0.377，P = 0.040）。 结论：超声监测肠系膜上动脉血流速变化有效预测机械通气病人肠内营养不耐受。
Abstract:
Objective: To explore the predictive value of blood flow velocity changes in superior mesentericartery (SMA) monitored by ultrasound on feeding intolerance (FI) of enteral nutrition (EN) in mechanically ventilatedICU patients. Methods: One-hundred and eight mechanically ventilated patients in Intensive Care Department of theSecond People’s Hospital of Nantong from February 2022 to February 2023 were enrolled. SMA blood flow parametersand enteral nutrition tolerance were monitored on the 1st, 3rd, and 7th day (D1, D3, D7) after initiation of EN.Differences in SMA blood flow parameters between tolerant and intolerant group, as well as intolerant subgroups (mild,moderate, and severe) were analyzed. The predictive value of SMA blood flow parameters for FI and the risk factors of FI were also evaluated, and the relationship between SMA blood flow parameters and intestinal barrier function werepreliminarily explored . Result: The SMA blood flow velocity parameters, peak systolic velocity (PSV) and enddiastolic velocity (EDV), were higher at D1, D3, and D7 in the tolerant groups compared to the intolerant group (all P <0.05). Subgroup analysis showed that as the degree of intolerance increased, PSV gradually decreased. EDV at D1, D3,and D7 also gradually decreased with the increased severity of FI (all P < 0.05); The AUC of PSV and EDV predicting FIin D1, D3, and D7 patients were 0.752 (95% CI: 0.660 ~ 0.830) and 0.773 (95% CI: 0.682 ~ 0.848), 0.774 (95% CI:0.683 ~ 0.849) and 0.796 (95% CI: 0.708 ~ 0.868), 0.743 (95% CI: 0.650 ~ 0.822) and 0.713 (95% CI: 0.618 ~ 0.796).respectively. PSV, norepinephrine use, and blood phosphorus levels were independent prognostic factors for FI at D3.Patients with FI showed a negative correlation between PSV, EDV, and diamine oxidase (PSV: r = -0.857, P < 0.001;EDV: r = -0.795, P < 0.001). Conclusion: Changes in blood flow velocity in the superior mesenteric artery byultrasound monitoring can effectively predict enteral nutrition intolerance in mechanically ventilated patients, it mighthave potential clinical application values in ICU patients.

参考文献/References:


[1] Sing P, Blaser AR, Berger MM, et al. ESPEN guideline onclinical nutrition in the intensive care unit. Clin Nutr, 2019, 38(1):48-79.
[2] Mcclave SA, Taylor BE, Martindale RG, et al. Guidelines for theProvision and Assessment of Nutrition Support Therapy in theAdult Critically Ill Patient: Society of Critical Care Medicine(SCCM) and American Society for Parenteral and EnteralNutrition (A. S. P. E. N.). JPEN J Parenter Enteral Nutr, 2016, 40(2): 159-211.
[3] 中华医学会肠外肠内营养学分会. 中国成人患者肠外肠内营养临 床 应 用 指 南（2023 版）. 中 华 医 学 杂 志 , 2023, 103(13):946-974.
[4] Reintam Blaser A, Malbrain M, Starkopf J, et al. Gastrointestinalfunction in intensive care patients: terminology, definitions andmanagement. Recommendations of the ESICM Working Groupon Abdominal Problems. Intensive Care Medicine, 2012, 38(3):384-394.
[5] Mcclave SA, Gualdoni J, Nagengast A, et al. GastrointestinalDysfunction and Feeding Intolerance in Critical Illness: Do WeNeed an Objective Scoring System?. Current GastroenterologyReports, 2020, 22(1): 1.
[6] Reintam Blaser A, Starkopf L, Deane A M, et al. Comparison ofdifferent definitions of feeding intolerance: A retrospectiveobservational study. Clin Nutr, 2015, 34(5): 956-961.
[7] 王瑞晨（编译, 胡森（审校. 3种营养途径对人肠系膜上动脉血流的影响. 中国危重病急救医学, 2009, 21(2):94-94.
[8] Murphy C, Baskind S, Aladangady N, et al. Measuring gutperfusion and blood flow in neonates using ultrasound Doppler ofthe superior mesenteric artery: a narrative review. Front Pediatr,2023, 11:1154611.
[9] Robel-Tillig E, Knüpfer M, Pulzer F, et al. Blood flow parametersof the superior mesenteric artery as an early predictor of intestinaldysmotility in preterm infants. Pediatr Radiol, 2004, 34(12):958-962.
[10] Huber TS, Bjorck M, Chandra A, et al. Chronic mesentericischemia: Clinical practice guidelines from the Society forVascular Surgery. J Vasc Surg, 2021, 73(1S): 87S-115S.
[11] 张延彬,曹子洋,张蓓蓓,等 . 急性肠缺血的彩色多普勒超声评价. 中国实用医刊, 2010, 37(21): 13-14.
[12] 徐 瑶，叶向红,李嘉琪,等. 腹部创伤病人肠内营养喂养不耐受的影响因素分析及对预后影响的研究.肠外与肠内营养, 2023,30(6):351-356.
[13] 叶向红, 宫雪梅, 王慧君, 等. 早期肠内营养耐受性分级干预在重症病人中的应用. 肠外与肠内营养,2020,27(2):89-93.
[14] 亚洲急危重症协会中国腹腔重症协作组. 重症病人胃肠功能障碍肠内营养专家共识（2021 版）. 中华消化外科杂志, 2021, 20(11):1123-1136.
[15] 中国腹腔重症协作组. 重症患者腹内高压监测与管理专家共识(2020版). 中华消化外科杂志, 2020, 19(10): 1030-1037.
[16] 全殷殷, 张 帅, 陈娟红, 等. ICU患者早期肠内营养耐受性监测系统的构建与应用.中华护理杂志,2022,57(7):773-778.
[17] Reintam Blaser A, Deane A M, Preiser J C, et al. Enteral FeedingIntolerance: Updates in Definitions and Pathophysiology. NutrClin Pract. 2021, 36(1): 40-49.
[18] Deane AM, Adam MD, Dhaliwal R, et al. Comparisons betweenintragastric and small intestinal delivery of enteral nutrition in thecritically ill: a systematic review and meta-analysis. Critical care(London, England), 2013, 17(3): R125.
[19] Veldscholte K, Veen MAN , Eveleens RD, et al. Earlyhypophosphatemia in critically ill children and the effect ofparenteral nutrition: A secondary analysis of the PEPaNIC RCT.Clin Nutr, 2022, 41(11): 2500-2508.
[20] Heyland DK, Ortiz A, Stoppe C, et al. Incidence, Risk Factors,and Clinical Consequence of Enteral Feeding Intolerance in theMechanically Ventilated Critically Ill: An Analysis of aMulticenter, Multiyear Database. Crit Care Med, 2021, 49(1):49-59.
[21] 左俊焘, 李嘉琪, 徐 瑶, 等. 重症病人肠内营养中断现状及其对热卡达标的影响研究.肠外与肠内营养,2023,30(3):166-170.
[22] Doley J. Enteral Nutrition Overview. Nutrients, 2022, 14(11):2180.
[23] Wells DL. Provision of Enteral Nutrition During VasopressorTherapy for Hemodynamic Instability: An Evidence ‐ BasedReview. Nutr Clin Pract, 2012, 27(4): 521-526.

备注/Memo

备注/Memo:
基金项目 ：2019年度中国博士后科学基金第66批面上资助项目（2019M661909）；江苏省自然科学基金青年基金项目（BK20200965）；2021年省博后C类资助项目（2021K405C）；国家自然科学基金青年基金项目（82000497）作者简介 ：陈蓓蓓，主治医师，医学硕士，主要从事危重症方向医学研究。E-mail：413534106@qq.com通讯作者 ：刘肇修，E-mail：340190751@qq.com
更新日期/Last Update: 1900-01-01