腹部为基础的早期渐进性活动对气管插管重症监护患者胃动力的影响：一项随机对照试验。

The effects of abdominal-based early progressive mobilisation on gastric motility in endotracheally intubated intensive care patients: A randomised controlled trial.

机构信息

National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, China; Critical Care Medicine Center of Xiangya Hospital, Central South University, China; Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, China.

National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, China; Critical Care Medicine Center of Xiangya Hospital, Central South University, China.

出版信息

Intensive Crit Care Nurs. 2022 Aug;71:103232. doi: 10.1016/j.iccn.2022.103232. Epub 2022 Apr 7.

DOI:10.1016/j.iccn.2022.103232

PMID:35397977

Abstract

OBJECTIVE

To examine whether an abdominal-based early progressive mobilisation program improves gastric motility and reduces feeding intolerance in critically ill patients with endotracheal intubation.

DESIGN AND METHODS

A randomised controlled trial was designed. Adult patients admitted to the intensive care unit who were intubated and had an order for enteral nutrition were randomly assigned to partake in an three stages of abdominal-based progressive mobilisation program (passive abdominal massage, bed-side bicycle and ambulating) or standard of care. Gastric antral motility was measured by bedside ultrasound.

RESULTS

A total of 83 critically ill patients were included in the study. The intervention group displayed a statistically significant improvement in the antral motility index than the control group (p < .001), as well as in complications of feeding intolerance, including the incidence of abdominal distention (9.8% vs 33.3%, p = .009), vomiting (0% vs 16.7%, p = .019) and diarrhoea (22% vs 50%, p = .008). However, no significant difference for the full enteral feeding rate on the third day was observed between the groups.Furthermore, time on mechanical ventilation (4.52 ± 2.77 days vs 6.24 ± 3.90 days, p = .023) was shorter in intervention group, but no significant difference of length of intensive care unit stay was observed between the groups.

CONCLUSIONS

Implementation of an abdominal-based early progressive mobilisation program can improve gastric motility and feeding intolerance in critically ill patients with an endotracheal tube.

摘要

目的

探讨腹部为基础的早期渐进性运动方案是否能改善气管插管危重症患者的胃动力，减少喂养不耐受。

设计和方法

采用随机对照试验设计。纳入入住重症监护病房、气管插管且有肠内营养医嘱的成年患者，随机分配至腹部为基础的渐进性运动方案（被动腹部按摩、床边自行车和走动）组或常规护理组。采用床边超声测量胃窦部蠕动。

结果

共纳入 83 例危重症患者。与对照组相比，干预组胃窦部蠕动指数有显著改善（p<0.001），喂养不耐受并发症，包括腹胀（9.8% vs 33.3%，p=0.009）、呕吐（0% vs 16.7%，p=0.019）和腹泻（22% vs 50%，p=0.008）的发生率也有所降低。然而，两组第 3 天的完全肠内喂养率无显著差异。此外，干预组机械通气时间（4.52±2.77 天 vs 6.24±3.90 天，p=0.023）更短，但两组重症监护病房住院时间无显著差异。