Division of General Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
Crit Care Clin. 2010 Jul;26(3):481-90, viii-ix. doi: 10.1016/j.ccc.2010.04.010.
The practice of measuring gastric residual volumes (GRVs) has become a routine part of enteral feeding protocols in the critical care setting. However, little scientific evidence indicates that their use improves patient outcomes. The use of GRVs is more of a tradition, which unfortunately guides the delivery of enteral nutrition (EN). The practice of GRVs is predicated on several flawed assumptions. Using GRVs in hospitalized patients assumes that the practice is well standardized, that GRVs reliably and accurately measure gastric contents, and that they sufficiently distinguish normal from abnormal emptying. The practice also assumes that GRVs are easy to interpret, that a tight correlation exists between GRVs and aspiration, and that continuing EN after a high value for GRV is obtained leads to pneumonia and adverse patient outcomes. And finally, clinicians assume that GRVs are an inexpensive "poor man's test" for determining tolerance of EN. This article reviews studies showing the fallacies of these assumptions. Although clinicians are unlikely to stop using GRVs, interpretation of these must be modified so as not to interrupt the delivery of EN. Using a protocol that directs appropriate responses to elevated GRVs should promote the delivery of EN and improve patient outcome.
测量胃残留量（GRV）已成为重症监护环境中肠内喂养方案的常规部分。然而，几乎没有科学证据表明它们的使用可以改善患者的预后。GRV 的使用更多的是一种传统，不幸的是，它指导了肠内营养（EN）的输送。GRV 的使用基于几个有缺陷的假设。在住院患者中使用 GRV 假设该实践得到了很好的标准化，GRV 能够可靠且准确地测量胃内容物，并且能够充分区分正常和异常排空。该实践还假设 GRV 易于解释，GRV 与吸入之间存在紧密的相关性，并且在获得高 GRV 值后继续进行 EN 会导致肺炎和患者不良预后。最后，临床医生假设 GRV 是确定 EN 耐受性的一种廉价的“穷人测试”。本文回顾了表明这些假设错误的研究。尽管临床医生不太可能停止使用 GRV，但必须修改对这些的解释，以免中断 EN 的输送。使用一种方案，针对升高的 GRV 做出适当的反应，应促进 EN 的输送并改善患者的预后。
