重症超声在重症患者肠内营养风险筛查及指导实施策略中的应用进展

doi:10.3969/j.issn.1004-583X.2024.12.016

摘要/Abstract

摘要：

重症监护病房(intensive care unit,ICU)患者常合并多器官衰竭。由于消化器官的自我调节能力较弱,重症患者常发生不同程度的胃肠功能紊乱、胃潴留、肠道血运障碍和肌肉萎缩,严重影响营养物质的吸收。近年来急危重症理念和床旁超声技术相结合,可多维度、多器官对ICU患者进行监测,快速有效进行营养状态评估和风险筛查,及时发现问题并调整喂养策略。对ICU患者营养方案的实施有较高价值,已成为目前的研究热点之一。本文对重症超声在ICU患者营养评估的多个方面进行综述,旨在为临床提供参考。

关键词: 重症监护病房, 肠内营养, 重症超声, 肌, 骨骼, 胃肠功能障碍

中图分类号:

R197.3

赵浩天, 龙玲, 任珊, 王华伟, 贺法强, 赵鹤龄. 重症超声在重症患者肠内营养风险筛查及指导实施策略中的应用进展[J]. 临床荟萃, 2024, 39(12): 1147-1152.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.12.016

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I12/1147

图/表 4

图1 胃窦超声图 a. 空腔胃窦;b. 胃腔内液性食糜及胃管置入;c. 胃腔内固体食物;d. 胃肠气体较多

图2 肠管和肠道血流超声图 a. 扩张积液的肠管;b. 肠系膜上动脉血流频谱

图3 肌肉组织超声图 a. 股直肌横截面;b. 膈肌

图4 重症超声在肠内营养实施中应用方案

参考文献 36

[1]	张钧凯, 邢云飞, 买璞杰, 等. 早期肠内营养支持对接受机械通气治疗的急危重症患者的效果[J]. 临床荟萃, 2020, 35(3):251-254.
[2]	Magnan C, Lancry T, Salipante F, et al. Role of gut microbiota and bacterial translocation in acute intestinal injury and mortality in patients admitted in ICU for septic shock[J]. Front Cell Infect Microbiol, 2023, 13:1330900.
[3]	Liu X, Wang Q, Yang D, et al. Association between Gastrointestinal Dysfunction Score (GIDS) and disease severity and prognosis in critically ill patients: A prospective, observational study[J]. Clin Nutr, 2023, 42(5):700-705. doi: 10.1016/j.clnu.2023.03.004 pmid: 36958226
[4]	赵浩天, 龙玲, 任珊, 等. 超声监测胃残余量对肠内营养实施的指导和评估新进展[J]. 肠外与肠内营养, 2020, 27(1):56-60.
[5]	Pérez-Calatayud ÁA, Carillo-Esper R. Role of gastric ultrasound to guide enteral nutrition in the critically ill[J]. Curr Opin Clin Nutr Metab Care, 2023, 26(2):114-119.
[6]	Chapple LS, Summers MJ, Weinel LM, et al. Effects of standard vs energy-dense formulae on gastric retention, energy delivery, and glycemia in critically ill patients[J]. JPEN J Parenter Enteral Nutr, 2021, 45(4):710-719.
[7]	Kannamani B, Panneerselvam S, Rudingwa P, et al. Comparison of ultrasonographic measurement of gastric antral volume and pH with or without pharmacological acid aspiration prophylaxis in low-risk surgical patients - A randomized clinical trial[J]. J Anaesthesiol Clin Pharmacol, 2024, 40(2):299-304. doi: 10.4103/joacp.joacp_412_22 pmid: 38919423
[8]	Srinivasareddy S. Gastric ultrasound for gastric content evaluation[J]. Turk J Anaesthesiol Reanim, 2023, 51(6):465-469. doi: 10.4274/TJAR.2023.231479 pmid: 38149347
[9]	Perlas A, Davis L, Khan M, et al. Gastric sonography in the fasted surgical patient:A prospective descriptive study[J]. Anesth Analg, 2011, 113(1): 93-97. doi: 10.1213/ANE.0b013e31821b98c0 pmid: 21596885
[10]	尹万红, 王小亭, 刘大为, 等. 重症超声临床应用技术规范[J]. 中华内科杂志, 2018, 57(6):397-417.
[11]	Qamar MI, Read AE, Mountford R. Increased superior mesenteric artery blood flow after glucose but not lactulose ingestion[J]. Q J Med, 1986, 60(233):893-896.
[12]	Wang L, Zhong X, Yang H, et al. When can we start early enteral nutrition safely in patients with shock on vasopressors?[J]. Clin Nutr ESPEN, 2024, 61:28-36. doi: 10.1016/j.clnesp.2024.03.007 pmid: 38777444
[13]	Watanabe K, Shiba T, Takahara A, et al. Evaluating the relationship between ocular blood flow and systemic organ blood flow in hemorrhagic shock using a rabbit model[J]. Sci Rep, 2024, 14(1):3749.
[14]	Wang LZ, Xiang Y, Li Q, et al. Risk factors of enternal nutrition intolerance in septic patients: A case-control study[J]. Curr Med Sci, 2024, 44(2):328-332. doi: 10.1007/s11596-024-2849-3 pmid: 38517677
[15]	Liu J, Xu Z, Luo S, et al. Risk factors for ICU-acquired weakness in sepsis patients: A retrospective study of 264 patients[J]. Heliyon, 2024, 10(11):e32253.
[16]	Zhang Q, Wang X, Liu M, et al. Assessing the diagnostic efficacy of handgrip dynamometry and diaphragmatic ultrasound in intensive care unit-acquired weakness[J]. J Multidiscip Healthc, 2024, 17:2359-2370. doi: 10.2147/JMDH.S462297 pmid: 38774623
[17]	Port AM, Apovian C. Metabolic support of the obese intensive care unit patient:A current perspective[J]. Curr Opin Clin Nutr Metab Care, 2010, 13(2):184-191.
[18]	蒋小芝, 王华伟, 赵浩天, 等. 骨骼肌超声在急危重症病人营养状态评估中的应用[J]. 肠外与肠内营养, 2019, 26(6):372-376.
[19]	Takahashi Y, Morisawa T, Okamoto H, et al. Diaphragm dysfunction and ICU-acquired weakness in septic shock patients with or without mechanical ventilation:A pilot prospective observational study[J]. J Clin Med, 2023, 12(16):5191.
[20]	Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness[J]. JAMA, 2013, 310(15):1591-1600. doi: 10.1001/jama.2013.278481 pmid: 24108501
[21]	Wu H, Chasteen B. Rapid review of ventilator-induced diaphragm dysfunction[J]. Respir Med, 2024, 223:107541.
[22]	赵浩天, 白杨, 燕亚茹, 等. 肺超声—理论与临床诊断规范[M]. 上海: 上海科学技术文献出版社, 2023.
[23]	Albano D, Messina C, Vitale J, et al. Imaging of sarcopenia: Old evidence and new insights[J]. Eur Radiol, 2020, 30(4):2199-2208. doi: 10.1007/s00330-019-06573-2 pmid: 31834509
[24]	Rodrigues CN, Ribeiro Henrique J, Ferreira ÁRS, et al. Ultrasonography and other nutrition assessment methods to monitor the nutrition status of critically ill patients[J]. JPEN J Parenter Enteral Nutr, 2021, 45(5):982-990.
[25]	Rollinson TC, Connolly B, Denehy L, et al. Ultrasound-derived rates of muscle wasting in the intensive care unit and in the post-intensive care ward for patients with critical illness: Post hoc analysis of an international, multicentre randomised controlled trial of early rehabilitation[J]. Aust Crit Care, 2024, 37(6):873-881. doi: 10.1016/j.aucc.2024.03.007 pmid: 38834392
[26]	Buitrago NDC, Gallego DT, Pérez MCF, et al. Assessment of quadriceps muscle mass by ultrasound in the postoperative period of cardiac surgery[J]. Ultrasound J, 2024, 16(1):8. doi: 10.1186/s13089-023-00348-z pmid: 38345655
[27]	Peres LM, Luis-Silva F, Menegueti MG, et al. Comparison between ultrasonography and computed tomography for measuring skeletal muscle mass in critically ill patients with different body mass index[J]. Clin Nutr ESPEN, 2024, 59:214-224. doi: 10.1016/j.clnesp.2023.12.012 pmid: 38220379
[28]	Puthucheary ZA, Phadke R, Rawal J, et al. Qualitative ultrasound in acute critical illness muscle wasting[J]. Crit Care Med, 2015, 43(8): 1603-1611. doi: 10.1097/CCM.0000000000001016 pmid: 25882765
[29]	Song J, Luo Q, Lai X, et al. Combined cardiac, lung, and diaphragm ultrasound for predicting weaning failure during spontaneous breathing trial[J]. Ann Intensive Care, 2024, 14(1):60. doi: 10.1186/s13613-024-01294-2 pmid: 38641687
[30]	赵浩天, 燕亚茹, 刘奕, 等. 膈肌和肋间肌增厚率及肋间肌代偿指数评估老年机械通气患者呼吸肌功能[J]. 中国医学影像技术, 2021, 37(9):1396-1400.
[31]	曹岚, 张丽娜, 王小亭, 等. 重症超声技术辅助实施新冠肺炎病人肠内营养3例报告[J]. 肠外与肠内营养, 2021, 28(1):60-64.
[32]	Arunachala Murthy T, Chapple LS, Lange K, et al. Gastrointestinal dysfunction during enteral nutrition delivery in intensive care unit (ICU) patients: Risk factors, natural history, and clinical implications. A post-hoc analysis of the augmented versus routine approach to giving energy trial (TARGET)[J]. Am J Clin Nutr, 2022, 116(2):589-598. doi: 10.1093/ajcn/nqac113 pmid: 35472097
[33]	Taggarsi DA, Sampath S. Acute gastrointestinal injury in critically ill patients in a South Indian intensive care unit: A prospective, observational, preliminary study[J]. Cureus, 2024, 16(5):e60903.
[34]	Guinot PG, Gallner D, De Baros JD, et al. Exploring the association between gastrointestinal dysfunction and abdominal venous congestion in ICU[J]. Intensive Crit Care Nurs, 2024, 82:103639.
[35]	杨红晓, 马金兰, 陈静, 等. 应用超声动态监测胃残余量指导重症机械通气患者早期营养治疗逐步达标[J]. 中华危重病急救医学, 2024, 36(2): 172-177.
[36]	Yan Y, Zhao H, Yang C. Early diagnosis of aspiration pneumonia by gastrointestinal ultrasound combined with lung ultrasound[J]. Med Ultrason, 2024, 26(1):104-105. doi: 10.11152/mu-4344 pmid: 38537195

重症超声在重症患者肠内营养风险筛查及指导实施策略中的应用进展

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 36

相关文章 15

编辑推荐

Metrics

本文评价

[1]	史莎莎, 任昊天, 宋丽菲, 李佳妮, 周岩, 张雁. 重症脑卒中患者肠内营养后高血糖管理的最佳证据总结[J]. 临床荟萃, 2024, 39(11): 1000-1006.
[2]	曾学英, 尹万红, 秦瑶, 王艺萍, 曹良海, 雷贤英, 廖雪莲, 四川省国际医学交流促进会重症超声与血流动力学专业委员会. 四川省三级医院重症超声应用现况及需求调查[J]. 临床荟萃, 2024, 39(11): 993-999.
[3]	尤奕, 高淑清, 徐浩. 肠内营养对食管癌患者术后临床结局影响的系统综述[J]. 临床荟萃, 2023, 38(6): 485-492.
[4]	王友芳, 李兴超, 朱晓松, 周廷发, 张建国, 杨淑红, 相然, 张蒙蒙, 车峰远. 肾功能亢进对重症监护室老年患者注射用头孢哌酮舒巴坦钠应用疗效的预测价值[J]. 临床荟萃, 2023, 38(4): 335-339.
[5]	郭皓, 庄蕙萃, 杨丽梅, 任敬, 崔东升, 张丽然. 2019-2021年我院重症医学科病原菌感染特点及耐药性分析[J]. 临床荟萃, 2022, 37(6): 519-524.
[6]	张志萍, 张宝民, 秦伟, 高凌杰, 陈冬. 肠内营养支持对慢性阻塞性肺病急性加重期机械通气患者营养和预后的影响[J]. 临床荟萃, 2022, 37(6): 510-514.
[7]	杨旻星, 庄姝洁, 韩文娟, 张海云, 叶赟. 低纤维肠内营养素对糖尿病患者肠道准备质量、血糖及舒适度的影响[J]. 临床荟萃, 2022, 37(4): 349-353.
[8]	郭皓, 任敬, 杨丽萍, 刘天歌. 重症监护病房患者谵妄筛查工具的临床使用[J]. 临床荟萃, 2022, 37(2): 162-165.
[9]	张圆, 黄涛, 王保平. 血乳酸辅助APACHEⅡ判断ICU老年重症感染患者预后的临床意义[J]. 临床荟萃, 2021, 36(7): 604-607.
[10]	王欢欢, 焦会芳, 王菲. 重症患儿发生压力性损伤风险的高危因素分析[J]. 临床荟萃, 2020, 35(5): 425-428.
[11]	吴菲霞1, 庄一渝2, 陈香萍2, 温焕1, 周洪昌1. ICU患者家属参与决策的现况研究[J]. 临床荟萃, 2020, 35(1): 67-71.
[12]	林翊君，林杉，王世彪. 婴儿支气管肺炎合并急性心力衰竭的预测因素分析[J]. 临床荟萃, 2018, 33(8): 687-690.
[13]	田雨，李俊霞，王化虹. 炎症性肠病的肠内营养治疗与肠道菌群[J]. 临床荟萃, 2018, 33(8): 661-665.
[14]	葛超毅, 王化虹. 炎症性肠病营养支持治疗进展[J]. 临床荟萃, 2018, 33(8): 650-655,660.
[15]	马敬，郭建华，叶玮，张涛. 心脏外科手术后患者再入ICU发生率的系统评价和meta分析[J]. 临床荟萃, 2018, 33(10): 897-903.