Juvé-Udina Maria-Eulàlia, Valls-Miró Consol, Carreño-Granero Avelina, Martinez-Estalella Gemma, Monterde-Prat David, Domingo-Felici Carmen-Maria, Llusa-Finestres Joan, Asensio-Malo Gemma
IDIBELL, Catalan Institute of Health, Gran Via de les Corts Catalanes, 587, Barcelona 08007, Spain.
Intensive Crit Care Nurs. 2009 Oct;25(5):258-67. doi: 10.1016/j.iccn.2009.06.004. Epub 2009 Jul 16.
The control of gastric residual volume (GRV) is a common nursing intervention in intensive care; however the literature shows a wide variation in clinical practice regarding the management of GRV, potentially affecting patients' clinical outcomes. The aim of this study is to determine the effect of returning or discarding GRV, on gastric emptying delays and feeding, electrolyte and comfort outcomes in critically ill patients.
A randomised, prospective, clinical trial design was used to study 125 critically ill patients, assigned to the return or the discard group. Main outcome measure was delayed gastric emptying. Feeding outcomes were determined measuring intolerance indicators, feeding delays and feeding potential complications. Fluid and electrolyte measures included serum potassium, glycaemia control and fluid balance. Discomfort was identified by significant changes in vital signs.
Patients in both groups presented similar mean GRV with no significant differences found (p=0.111), but participants in the intervention arm showed a lower incidence and severity of delayed gastric emptying episodes (p=0.001). No significant differences were found for the rest of outcome measurements, except for hyperglycaemia.
The results of this study support the recommendation to reintroduce gastric content aspirated to improve GRV management without increasing the risk for potential complications.
控制胃残余量（GRV）是重症监护中常见的护理干预措施；然而，文献表明，在GRV管理的临床实践中存在很大差异，这可能会影响患者的临床结局。本研究的目的是确定回输或丢弃GRV对重症患者胃排空延迟、喂养、电解质及舒适度结局的影响。
采用随机、前瞻性临床试验设计，对125例重症患者进行研究，分为回输组和丢弃组。主要结局指标是胃排空延迟。通过测量不耐受指标、喂养延迟和喂养潜在并发症来确定喂养结局。液体和电解质指标包括血清钾、血糖控制和液体平衡。通过生命体征的显著变化来确定不适情况。
两组患者的平均GRV相似，差异无统计学意义（p = 0.111），但干预组患者胃排空延迟发作的发生率和严重程度较低（p = 0.001）。除高血糖外，其余结局指标差异均无统计学意义。
本研究结果支持重新引入吸出的胃内容物以改善GRV管理的建议，且不会增加潜在并发症的风险。
