Application Of Intra-abdominal Pressure Combined With Ultrasound Monitoring Of Gastric Residue In Enteral Nutrition Of Severe Stroke Patients

ObjectivesCompare the sensitivity of using intra-abdominal pressure monitoring and using ultrasound to monitor gastric residual volume in predicting enteral nutrition intolerance in severe stroke patients,and explore whether there is a difference in the evaluation of enteral nutrition intolerance in severe stroke patients between the combination of the two monitoring methods and the single application,in order to find the best monitoring method suitable for enteral nutrition treatment in severe stroke patients.MethodsA total of 157 patients with severe stroke admitted to the Neurosurgical Care Unit(NICU)of a Class III Grade A hospital in Qingdao from July 2021 to December2022 were selected as the study subjects.The patients were divided into four groups using a random number table method,including 39 in the control group,39 in the trial group 1,40 in the trial group 2,and 39 in the trial group 3.All patients in the four groups started early enteral nutrition support and received symptomatic treatment and routine care.The control group was a conventional gastric residue monitoring group,which was monitored by syringe aspiration method;Test group 1was intraabdominal pressure monitoring group;Test group 2 was ultrasound gastric residue monitoring group;The test group 3 was an intraabdominal pressure combined with ultrasonic gastric residual monitoring group,with a frequency of Q4 h.The time of reaching the target feeding amount for enteral nutrition,the rate of reaching the target feeding rate on the 7th day,the incidence of enteral nutrition intolerance,serum nutritional indicators,Acute Physiology and Chronic Health Evaluation II(APACHE II),and the length of stay in the psychiatric surgical care unit of the four groups of patients were observed.Results1.There were no statistically significant differences between the four groups in baseline data such as gender,age,diagnosis,nutritional risk assessment 2002 score,body mass index,Glasgow score,and mechanical ventilation(P>0.05).2.There was a statistically significant difference in the incidence of enteral nutrition intolerance between groups 1,2,and 3 and the control group(35.90% vs25.00% vs 7.69% vs 58.97%,P<0.01);The incidence rate of the experimental group was lower than that of the control group,and the difference was statistically significant(P<0.05);There was no statistically significant difference between Experiment 1 and Experiment 2(P>0.05);The results of Experiment 3 were better than those of Experiment 1 and Experiment 2,with statistical differences(P<0.05).3.There was a statistically significant difference in the time when the target feeding amount for enteral nutrition was met among the four groups of patients(P<0.01);The experimental group was better than the control group(P<0.01);There was no statistical difference between Experiment 1 and Experiment 2(P>0.05);The experimental group 3 was superior to the experimental groups 1 and 2,and the difference was statistically significant(P<0.05).4.There was a statistically significant difference in the feeding compliance rate between groups 1,2,and 3 and the control group on the 7th day(76.92% vs 87.18%vs 92.31% vs 53.85%,P<0.01);The experimental group was higher than the control group(P<0.05);There was no statistically significant difference between the experimental groups(P>0.05).5.There was a statistically significant difference in serum nutritional indicators among the four groups of patients after intervention(P<0.01);The experimental group was higher than the control group(P<0.01);The albumin levels in Experiment2 were significantly higher than those in Experiment 1(P<0.05),while the difference in prealbumin levels was not statistically significant(P>0.05);The levels of albumin and prealbumin in Experiment 3 were significantly higher than those in Experiment 1(P<0.01);The albumin levels in Experiment 3 were higher than those in Experiment2(P<0.01),and there was no statistically significant difference in prealbumin between the two groups(P>0.05).6.There was a statistically significant difference in APACHE II scores among the four groups of patients after intervention(P<0.01);The experimental group was better than the control group(P<0.01);There was no statistically significant difference between Experiment 1 and Experiment 2(P>0.05);The experimental group 3 was superior to the experimental groups 1 and 2,and the difference was statistically significant(P<0.05).7.There was no statistically significant difference in NICU hospitalization time among the four groups of patients(P>0.05).Conclusions1.For patients with severe stroke who initiate enteral nutrition in the early stage,using intra-abdominal pressure monitoring and ultrasound gastric residue monitoring can effectively shorten the time for reaching the target feeding amount of enteral nutrition,improve the patient’s nutritional status,and improve prognosis.2.There was no significant difference in the evaluation of enteral nutrition intolerance in severe stroke patients between the use of intra-abdominal pressure monitoring and ultrasound gastric residue monitoring alone.3.The effect of using intra-abdominal pressure combined with ultrasound gastric residue monitoring for patients is significantly better than that of simple intra-abdominal pressure monitoring and simple ultrasound gastric residue monitoring.The combination of the two has a synergistic effect and has a significant impact on patients,which is worthy of clinical promotion.