Gao Hongmei, Yao Junli, Lu Ling, Dou Lin, Chang Wenxiu
Department of Critical Care Medicine, Institute of Emergency Medicine, Tianjin First Center Hospital, Tianjin 300192, China. Corresponding author: Chang Wenxiu, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Apr;26(4):214-8. doi: 10.3760/cma.j.issn.2095-4352.2014.04.003.
To study the feasibility of the acute gastrointestinal injury (AGI) classification standard for evaluation of gastrointestinal function in intensive care unit (ICU) patients, and to discuss its value in administration of early enteral nutrition (EN).
A perspective study was conducted. 85 patients with AGI admitted to ICU of Tianjin First Center Hospital from January 2013 to June 2013 were enrolled. EN was conducted after ICU admission or within 12-24 hours after high catabolic state. The patients were divided into four groups according to the AGI classification, i.e. grade I, II, III, and IV, and they were treated according to the treatment procedure for AGI. The primary end points were 7-day rate of intake of standard EN, the degree of disease and nutrition, and their correlation with AGI classification. Secondary endpoint was rate of giving EN within 48 hours.
Gastrointestinal dysfunction patients accounted for 49.42% (85/172) of the ICU patients, and number of patients in grade I, II, III, IV were 29, 28, 19, 9 respectively. On the first day of ICU stay, there were no statistical differences in age, acute physiology and chronic health evaluation II (APACHEII) score, serum albumin (ALB) and prealbumin (PA) among four groups, and it was demonstrated that the baseline data were comparable. APACHEII score on the seventh day of ICU stay was significantly lower than that on the first day in grade I, II and III patients (grade I: 20.48±2.45 vs. 22.59±2.06, t=-3.120, P=0.031; grade II: 19.34±1.80 vs. 21.65±2.22, t=-4.316, P=0.012; grade III: 20.63±1.34 vs. 23.31±1.70, t=-5.640, P=0.000), and serum PA was significantly increased (grade I: 24.37±6.54 g/L vs. 10.62±7.24 g/L, t=-4.866, P=0.000; grade II: 19.79±12.48 g/L vs. 11.57±8.94 g/L, t=-2.116, P=0.031; grade III: 19.15±8.43 g/L vs. 13.78±6.59 g/L, t=-3.601, P=0.000). On the seventh day of ICU stay, the APACHEII score was higher in grade IV than that in grade I, II and III patients (22.87±3.31 vs. 20.48±2.45, 19.34±1.80, 20.63±1.34, P<0.05 or P<0.01), and PA was obviously lower in grade IV than that in grade I, II and III patients (14.02±8.70 g/L vs. 24.37±6.54 g/L, 19.79±12.48 g/L, 19.15±8.43 g/L, P<0.05 or P<0.01). There was no statistically significant difference among four groups in respect of serum ALB (F=0.454, P=0.722). The rate of giving EN in 24 hours in grade I, II, III, IV patients was 95.4%, 72.1%, 52.0% and 0, respectively (χ2=8.310, P=0.016), and in 48 hours it was 100.0%, 83.0%, 76.0%, and 0 (χ2=5.470, P=0.025). 7-day standard EN intake rate was 100.0%, 88.7%, 84.0% and 34.0% respectively in grade I, II, III, IV patients (χ2=0.720, P=0.017). Correlation analysis showed that there was a negative correlation between AGI classification and rate of giving EN in 1 day (r=-0.62, P=0.04) and 7-day standard EN intake rate (r=-0.76, P=0.02).
AGI classification can be used to estimate the gastrointestinal function of patients with critical illness, and it has a significant correlation with early EN support. An early goal achieving intervention based on the AGI classification can improve the nutritional status and the general state of the patients.
探讨急性胃肠损伤（AGI）分级标准评估重症监护病房（ICU）患者胃肠功能的可行性，并探讨其在早期肠内营养（EN）实施中的价值。
进行一项前瞻性研究。纳入2013年1月至2013年6月在天津市第一中心医院ICU收治的85例AGI患者。在患者入住ICU后或处于高分解代谢状态后的12 - 24小时内开始实施EN。根据AGI分级将患者分为四组，即I级、II级、III级和IV级，并按照AGI的治疗程序进行治疗。主要终点为7天标准EN摄入率、疾病严重程度和营养状况及其与AGI分级的相关性。次要终点为48小时内给予EN的比例。
ICU患者中胃肠功能障碍患者占49.42%（85/172），I级、II级、III级、IV级患者分别为29例、28例、19例、9例。入住ICU第一天，四组患者在年龄、急性生理与慢性健康状况评分系统II（APACHEII）评分、血清白蛋白（ALB）和前白蛋白（PA）方面无统计学差异，表明基线数据具有可比性。I级、II级和III级患者入住ICU第七天的APACHEII评分显著低于第一天（I级：20.48±2.45 vs. 22.59±2.06，t = -3.120，P = 0.031；II级：19.34±1.80 vs. 21.65±2.22，t = -4.316，P = 0.012；III级：20.63±1.34 vs. 23.31±1.70，t = -5.640，P = 0.000），血清PA显著升高（I级：24.37±6.54 g/L vs. 10.62±7.24 g/L，t = -4.866，P = 0.000；II级：19.79±12.48 g/L vs. 11.57±8.94 g/L，t = -2.116，P = 0.031；III级：19.15±8.43 g/L vs. 13.78±6.59 g/L，t = -3.601，P = 0.000）。入住ICU第七天，IV级患者的APACHEII评分高于I级、II级和III级患者（22.87±3.31 vs. 20.48±2.45，19.34±1.80，20.63±1.34，P<0.05或P<0.01），IV级患者的PA明显低于I级、II级和III级患者（14.02±8.70 g/L vs. 24.37±6.54 g/L，19.79±12.48 g/L，19.15±8.43 g/L，P<0.05或P<0.01）。四组患者血清ALB差异无统计学意义（F = 0.454，P = 0.722）。I级、II级、III级、IV级患者24小时内给予EN的比例分别为95.4%、72.1%、52.0%和0（χ2 = 8.310，P = 0.016），48小时内分别为100.0%、83.0%、76.0%和0（χ2 = 5.470，P = 0.025）。I级、II级、III级、IV级患者7天标准EN摄入率分别为100.0%、88.7%、84.0%和34.0%（χ2 = 0.720，P = 0.017）。相关性分析显示，AGI分级与1天内给予EN的比例（r = -0.62，P = 0.04）和7天标准EN摄入率（r = -0.76，P = 0.02）呈负相关。
AGI分级可用于评估危重症患者的胃肠功能，且与早期EN支持显著相关。基于AGI分级实现早期目标干预可改善患者的营养状况和总体状态。
