目的 探讨血乳酸与休克患者肠内营养不耐受的相关性。方法 回顾性分析2015-01至2018-01收入ICU应用血管活性药物并开始肠内营养支持治疗的休克患者。依据胃残留(＞250 ml)、呕吐、腹平片或腹部CT阳性、肠管缺血或穿孔表现将患者分为肠内营养耐受组和肠内营养不耐受组,分别记录两组患者血管活性药物及剂量、血乳酸、肠内营养剂量与速度。分析血乳酸与肠内营养不耐受的关系。结果 本研究共纳入146例患者,其中肠内营养耐受组114例,肠内营养不耐受组32例,不耐受组患者的APACHEⅡ评分、SOFA评分、最大血管活性药物剂量与耐受组无明显差异。但血乳酸值高于耐受组(P<0.001),急性胃肠损伤分级程度高于耐受组(P<0.001)。多元回归分析校正急性胃肠损伤分级,显示血乳酸值升高(＞2.0 mmol/L)是肠内营养不耐受的独立预测因素[OR为6.8;95%CI(2.9~16.0)]。结论 休克患者血乳酸值高(＞2.0 mmol/L)时发生肠内营养不耐受风险较大。
Abstract
Objective To assess the correlations between serum lactate and intolerance of enteral nutrition(EN) in shock patients.Methods A retrospective study was conducted based on the review of medical records of ICU patients treated between January 1, 2015 and January 1, 2018. Shock patients who had received vasopressors and EN were included. Patients with a gastric residual volume ＞250 ml, vomiting, abnormalities in abdominal X ray or CT scan, intestinal ischemia or perforation were assigned to the intolerance group, and the rest to the tolerance group. The vasopressor dose, serum lactate level, EN amount and speed were recorded in both groups. The association of serum lactate with intolerance of enteral nutrition(EN) in shock patients was investigated.Results Among the 146 patients who had received EN and Ⅳ vasopressor therapy,114 were in the tolerance group, whereas 32 were in the intolerance group. The Acute Physiology and Chronic Health EvaluationⅡScores (APACHEⅡ), Sequential Organ Failure Assessment Scores(SOFA) and the maximum vasopressor dose of patients in the intolerance group were not significantly different from those of the tolerance group(P＞0.05). However, both the serum lactate level(P<0.001) and Acute Gastrointestinal Injury grade (AGI grade) (P＜0.001)of patients in the intolerance group were significantly higher than those in the tolerance group. Multiple regression analysis showed that an increased serum lactate level(＞2.0 mmol/L) was an independent predictor of EN intolerance[OR,6.8;95%CI(2.9-16.0)].Conclusions In patients with shock, the increased lactate level may predict the risk of EN intolerance.
关键词
肠内营养 /
急性胃肠损伤 /
耐受性 /
休克 /
血乳酸
Key words
enteral nutrition /
acute gastrointestinal injury /
tolerance /
shock
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基金
1.《基于大数据监测的老年眼毒症液体复苏及早期预警相关研究》项目编号:17BJ230,军队保障专项,2017.07-2020.06;2.吴阶平医学基金会临床科研专项资助基金(320.6750.17199)-CD8+调节性细胞和树突状细胞亚群在肝癌患者机体内的表达分布及其肿瘤免疫治疗潜力的研究。
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