目的 观察急性胃肠损伤(AGI)分级标准评估重症监护病房(ICU)患者胃肠道功能障碍的可行性,并探讨以此为基础的早期肠内营养(EN)方案实施的应用价值.方法 采用前瞻性研究方法,选择2013年1月至6月天津市第一中心医院ICU收治的85例胃肠道功能障碍患者,于入住ICU后或高代谢状态发作后12～24 h内实施EN.根据AGI分级将患者分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级4组,并按AGI治疗程序进行干预.观察主要终点:7dEN摄入量达标率、病情程度和营养状态,及其与AGI分级的相关性;次要终点:48 h内开展EN的比例.结果 胃肠道功能障碍患者占同期ICU收治患者的49.42％(85/172),Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者分别为29、28、19和9例.入ICU 1 d时,4组患者年龄、急性生理学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)含量比较差异均无统计学意义,基线资料均衡,有可比性.与入ICU 1 d时比较,7d时Ⅰ、Ⅱ、Ⅲ级患者APACHEⅡ评分(分)明显下降(Ⅰ级:20.48±2.45比22.59±2.06,t=-3.120,P=0.031;Ⅱ级:19.34±1.80比21.65±2.22,t=-4.316,P=0.012;Ⅲ级:20.63±1.34比23.31±1.70,t=-5.640,P=0.000),PA含量(g/L)明显升高(Ⅰ级:24.37±6.54比10.62±7.24,t=-4.866,P=0.000;Ⅱ级:19.79±12.48比11.57±8.94,t =-2.116,P=0.031;Ⅲ级:19.15±8.43比13.78±6.59,t=-3.601,P=0.000).入ICU 7 d时,Ⅳ级患者APACHEⅡ评分明显高于Ⅰ、Ⅱ、Ⅲ级患者(分:22.87±3.31比20.48±2.45、19.34±1.80、20.63±1.34,P＜0.05或P＜0.01),PA含量明显低于Ⅰ、Ⅱ、Ⅲ级患者(g/L:14.02±8.70比24.37±6.54、19.79±12.48、19.15±8.43,P＜0.05或P＜0.01);Ⅰ～Ⅳ级患者间ALB浓度差异无统计学意义(F=0.454,P=0.722).Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者24h喂养率分别为95.4％、72.1％、52.0％和0(x2=8.310,P=0.016);48 h喂养率分别为100.0％、83.0％、76.0％和0(x2=5.470,P=0.025);7 d热量达标率分别为100.0％、88.7％、84.0％和34.0％(x2=0.720,P=0.017).相关分析显示,AGI分级与1d喂养率(r=-0.62,P=0.04)及7d热量达标率(r=-0.76,P=0.02)存在负相关关系.结论 AGI分级可以初步评估危重病患者的胃肠道功能,且与其早期EN支持之间具有较好的相关性;以此为基础对制定胃肠道早期目标导向干预性治疗方案,可起到改善患者营养状态和疾病严重程度的作用.
目的 觀察急性胃腸損傷(AGI)分級標準評估重癥鑑護病房(ICU)患者胃腸道功能障礙的可行性,併探討以此為基礎的早期腸內營養(EN)方案實施的應用價值.方法 採用前瞻性研究方法,選擇2013年1月至6月天津市第一中心醫院ICU收治的85例胃腸道功能障礙患者,于入住ICU後或高代謝狀態髮作後12～24 h內實施EN.根據AGI分級將患者分為Ⅰ、Ⅱ、Ⅲ、Ⅳ級4組,併按AGI治療程序進行榦預.觀察主要終點:7dEN攝入量達標率、病情程度和營養狀態,及其與AGI分級的相關性;次要終點:48 h內開展EN的比例.結果 胃腸道功能障礙患者佔同期ICU收治患者的49.42％(85/172),Ⅰ、Ⅱ、Ⅲ、Ⅳ級患者分彆為29、28、19和9例.入ICU 1 d時,4組患者年齡、急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分、血清白蛋白(ALB)和前白蛋白(PA)含量比較差異均無統計學意義,基線資料均衡,有可比性.與入ICU 1 d時比較,7d時Ⅰ、Ⅱ、Ⅲ級患者APACHEⅡ評分(分)明顯下降(Ⅰ級:20.48±2.45比22.59±2.06,t=-3.120,P=0.031;Ⅱ級:19.34±1.80比21.65±2.22,t=-4.316,P=0.012;Ⅲ級:20.63±1.34比23.31±1.70,t=-5.640,P=0.000),PA含量(g/L)明顯升高(Ⅰ級:24.37±6.54比10.62±7.24,t=-4.866,P=0.000;Ⅱ級:19.79±12.48比11.57±8.94,t =-2.116,P=0.031;Ⅲ級:19.15±8.43比13.78±6.59,t=-3.601,P=0.000).入ICU 7 d時,Ⅳ級患者APACHEⅡ評分明顯高于Ⅰ、Ⅱ、Ⅲ級患者(分:22.87±3.31比20.48±2.45、19.34±1.80、20.63±1.34,P＜0.05或P＜0.01),PA含量明顯低于Ⅰ、Ⅱ、Ⅲ級患者(g/L:14.02±8.70比24.37±6.54、19.79±12.48、19.15±8.43,P＜0.05或P＜0.01);Ⅰ～Ⅳ級患者間ALB濃度差異無統計學意義(F=0.454,P=0.722).Ⅰ、Ⅱ、Ⅲ、Ⅳ級患者24h餵養率分彆為95.4％、72.1％、52.0％和0(x2=8.310,P=0.016);48 h餵養率分彆為100.0％、83.0％、76.0％和0(x2=5.470,P=0.025);7 d熱量達標率分彆為100.0％、88.7％、84.0％和34.0％(x2=0.720,P=0.017).相關分析顯示,AGI分級與1d餵養率(r=-0.62,P=0.04)及7d熱量達標率(r=-0.76,P=0.02)存在負相關關繫.結論 AGI分級可以初步評估危重病患者的胃腸道功能,且與其早期EN支持之間具有較好的相關性;以此為基礎對製定胃腸道早期目標導嚮榦預性治療方案,可起到改善患者營養狀態和疾病嚴重程度的作用.
목적 관찰급성위장손상(AGI)분급표준평고중증감호병방(ICU)환자위장도공능장애적가행성,병탐토이차위기출적조기장내영양(EN)방안실시적응용개치.방법 채용전첨성연구방법,선택2013년1월지6월천진시제일중심의원ICU수치적85례위장도공능장애환자,우입주ICU후혹고대사상태발작후12～24 h내실시EN.근거AGI분급장환자분위Ⅰ、Ⅱ、Ⅲ、Ⅳ급4조,병안AGI치료정서진행간예.관찰주요종점:7dEN섭입량체표솔、병정정도화영양상태,급기여AGI분급적상관성;차요종점:48 h내개전EN적비례.결과 위장도공능장애환자점동기ICU수치환자적49.42％(85/172),Ⅰ、Ⅱ、Ⅲ、Ⅳ급환자분별위29、28、19화9례.입ICU 1 d시,4조환자년령、급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분、혈청백단백(ALB)화전백단백(PA)함량비교차이균무통계학의의,기선자료균형,유가비성.여입ICU 1 d시비교,7d시Ⅰ、Ⅱ、Ⅲ급환자APACHEⅡ평분(분)명현하강(Ⅰ급:20.48±2.45비22.59±2.06,t=-3.120,P=0.031;Ⅱ급:19.34±1.80비21.65±2.22,t=-4.316,P=0.012;Ⅲ급:20.63±1.34비23.31±1.70,t=-5.640,P=0.000),PA함량(g/L)명현승고(Ⅰ급:24.37±6.54비10.62±7.24,t=-4.866,P=0.000;Ⅱ급:19.79±12.48비11.57±8.94,t =-2.116,P=0.031;Ⅲ급:19.15±8.43비13.78±6.59,t=-3.601,P=0.000).입ICU 7 d시,Ⅳ급환자APACHEⅡ평분명현고우Ⅰ、Ⅱ、Ⅲ급환자(분:22.87±3.31비20.48±2.45、19.34±1.80、20.63±1.34,P＜0.05혹P＜0.01),PA함량명현저우Ⅰ、Ⅱ、Ⅲ급환자(g/L:14.02±8.70비24.37±6.54、19.79±12.48、19.15±8.43,P＜0.05혹P＜0.01);Ⅰ～Ⅳ급환자간ALB농도차이무통계학의의(F=0.454,P=0.722).Ⅰ、Ⅱ、Ⅲ、Ⅳ급환자24h위양솔분별위95.4％、72.1％、52.0％화0(x2=8.310,P=0.016);48 h위양솔분별위100.0％、83.0％、76.0％화0(x2=5.470,P=0.025);7 d열량체표솔분별위100.0％、88.7％、84.0％화34.0％(x2=0.720,P=0.017).상관분석현시,AGI분급여1d위양솔(r=-0.62,P=0.04)급7d열량체표솔(r=-0.76,P=0.02)존재부상관관계.결론 AGI분급가이초보평고위중병환자적위장도공능,차여기조기EN지지지간구유교호적상관성;이차위기출대제정위장도조기목표도향간예성치료방안,가기도개선환자영양상태화질병엄중정도적작용.
Objective 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).Methods 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.Results 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 (APACHE Ⅱ) score,serum albumin (ALB) and prealbumin (PA) among four groups,and it was demonstrated that the baseline data were comparable.APACHE Ⅱ 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 (g/L) was significantly increased (grade Ⅰ:24.37 ± 6.54 vs.10.62 ± 7.24,t=-4.866,P=0.000; grade Ⅱ:19.79± 12.48 vs.11.57±8.94,t=-2.116,P=0.031; grade Ⅲ:19.15±8.43 vs.13.78 ± 6.59,t=-3.601,P=0.000).On the seventh day ofICU stay,the APACHE Ⅱ 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 (g/L:14.02 ± 8.70 vs.24.37 ± 6.54,19.79 ±12.48,19.15 ± 8.43,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 (x2=8.310,P=0.016),and in 48 hours it was 100.0％,83.0％,76.0％,and 0 (x2=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 (x2 =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).Conclusions 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.
