应用腹内压监测对严重多发伤患者早期空肠营养并发症的观察

摘要

Objective: To investigate the complications of early enteral nutrition of the severe multiple trauma patients by the intra-abdominal pressure monitoring.Method: 80 patients with multiple trauma were divided into the severe multiple trauma (the observation groups) and the mildly multiple monitoring trauma(the control groups) by the injury severity scoring(ISS). Intra-abdominal pressure of two groups were monitored. The observation group adjusted enteral nutrition according to the intra-abdominal pressure monitoring, but the control group used conventional methods. The Level of the intra-abdominal pressure, the mortality and the incidence rate of the complications of enteral nutrition between the two group were compared, and the score of MODS, the incidence rate of MODS, the case-fatality rate of the two groups were compared.Result: IAP, case fatality rate, viscera dysfunction rate and the incidence rate of the complications of enteral nutrition in the observation group were significantly higher than that of the control group, the differences were statistically significant (P<0.05).The observation group appeared different degree of abdominal distention, the patients’ abdominal girth changed obviously; the more severe abdominal distension, the greater the abdominal girth changed; patients’ intra-abdominal pressure and average difference value had a significant changed before and after the abdominal distention, diarrhea appeared, and the difference were statistically significant (P<0.05). Conclusion: Intra-abdominal pressure monitoring in patients with severe multiple trauma complications early jejunum nutrition has clinical significance, complications can effectively reduce the enteral nutrition for critically ill patients with serious consequences.%目的：研究应用腹内压监测（IAP）对严重多发伤患者早期空肠营养并发症的观察。方法：选取2012年1月-2013年11月收治的多发伤患者80例，按照创伤评分选出为严重多发伤患者（观察组）和轻度多发伤患者（对照组）。两组均进行腹内压监测，观察组根据监测的腹内压来调节肠内营养，对照组按照常规观察指导肠内营养。观察并比较两组患者的腹内压水平、病死率、肠内营养并发症的发生率；比较腹内压升高患者的MODS评分、器官功能障碍发生率、病死率。结果：观察组IAP测量值、病死率、发生脏器功能障碍率、肠内营养并发症发生率均明显高于对照组，差异均有统计学意义（P<0.05）。观察组出现不同程度的腹胀时，患者的腹围较前出现明显变化；腹胀程度越严重，腹围变化越大；而患者腹胀、腹泻出现前后的腹内压差值及及平均值也出现明显变化，差异有统计学意义（P<0.05）。结论：腹内压监测对严重多发伤患者早期空肠营养并发症的观察有临床指导意义，可以有效降低肠内营养并发症为危重患者带来的严重后果。