危重症患儿胃排空。
Gastric Emptying in Critically Ill Children.
机构信息
1 Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
2 Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
出版信息
JPEN J Parenter Enteral Nutr. 2017 Sep;41(7):1100-1109. doi: 10.1177/0148607116686330. Epub 2017 Jan 6.
BACKGROUND
Delayed gastric emptying (GE) impedes enteral nutrient (EN) delivery in critically ill children. We examined the correlation between (a) bedside EN intolerance assessments, including gastric residual volume (GRV); (b) delayed GE; and (c) delayed EN advancement.
MATERIALS AND METHODS
We prospectively enrolled patients ≥1 year of age, eligible for gastric EN and without contraindications to acetaminophen. Gastric emptying was determined by the acetaminophen absorption test, specifically the area under the curve at 60 minutes (AUC). Slow EN advancement was defined as delivery of <50% of the prescribed EN 48 hours after study initiation. EN intolerance assessments (GRV, abdominal distension, emesis, loose stools, abdominal discomfort) were recorded.
RESULTS
We enrolled 20 patients, median 11 years (4.4-15.5), 50% male. Sixteen (80%) patients had delayed GE (AUC <600 mcg·min/mL) and 7 (35%) had slow EN advancement. Median GRV (mL/kg) for patients with delayed vs normal GE was 0.43 (0.113-2.188) vs 0.89 (0.06-1.91), P = .9635. Patients with slow vs rapid EN advancement had median GRV (mL/kg) of 1.02 mL/kg (0.20-3.20) vs 0.27 mL/kg (0.06-1.62), P = .3114, and frequency of altered EN intolerance assessments of 3/7 (42.9%) vs 5/13 (38.5%), P = 1. Median AUC for patients with slow vs rapid EN advancement was 91.74 mcg·min/mL (53.52-143.1) vs 449.5 mcg·min/mL (173.2-786.5), P = .0012.
CONCLUSIONS
A majority of our study cohort had delayed GE. Bedside EN intolerance assessments, particularly GRV, did not predict delayed GE or rate of EN advancement. Delayed gastric emptying predicted slow EN advancement. Novel tests for delayed GE and EN intolerance are needed.
背景
延迟的胃排空（GE）会阻碍危重症儿童的肠内营养（EN）输送。我们研究了以下三者之间的相关性：（a）床边 EN 不耐受评估，包括胃残留量（GRV）；（b）延迟的 GE；以及（c）延迟的 EN 推进。
材料与方法
我们前瞻性纳入≥1 岁、适合胃内 EN 且无对乙酰氨基酚禁忌证的患者。通过乙酰氨基酚吸收试验（具体为 60 分钟时的曲线下面积[AUC]）来确定胃排空情况。EN 推进缓慢定义为研究启动后 48 小时内输送量<规定 EN 的 50%。记录 EN 不耐受评估（GRV、腹胀、呕吐、稀便、腹部不适）。
结果
我们共纳入 20 例患者，中位年龄 11 岁（4.4-15.5），50%为男性。16 例（80%）患者存在延迟 GE（AUC<600 mcg·min/mL），7 例（35%）患者存在 EN 推进缓慢。与正常 GE 相比，延迟 GE 患者的中位 GRV（mL/kg）为 0.43（0.113-2.188）比 0.89（0.06-1.91），P=.9635。与快速 EN 推进相比，EN 推进缓慢患者的中位 GRV（mL/kg）为 1.02 mL/kg（0.20-3.20）比 0.27 mL/kg（0.06-1.62），P=.3114，且 EN 不耐受评估改变的频率为 3/7（42.9%）比 5/13（38.5%），P=1。与快速 EN 推进相比，EN 推进缓慢患者的中位 AUC 为 91.74 mcg·min/mL（53.52-143.1）比 449.5 mcg·min/mL（173.2-786.5），P=.0012。
结论
我们研究队列中的大多数患者存在延迟 GE。床边 EN 不耐受评估，特别是 GRV，无法预测延迟 GE 或 EN 推进速度。延迟的 GE 预测了 EN 推进缓慢。需要新的检测方法来评估延迟的 GE 和 EN 不耐受。
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