Abstract: Objective　To explore the application of B-ultrasound guidance in enteral nutrition (EN) strategies for patients with traumatic brain injury undergoing invasive mechanical assisted ventilation. Methods　A total of 72 patients with traumatic brain injury undergoing invasive mechanical assisted ventilation admitted to the Intensive Care Unit (ICU) of Lianzhou People's Hospital from November 2019 to May 2021 were divided into a reference group (36 cases) and an experimental group (36 cases) by the random number table. In the reference group, there were 24 males and 12 females, aged (46.28±7.64) years; in the experimental group, there were 26 males and 10 females, aged (47.07±7.22) years. All patients in the two groups received EN treatment by indwelling nasogastric tube within 24-72 hours after admission. The reference group adopted the traditional EN scheme formulated according to the clinical experiences, and the experimental group adopted the EN scheme of invasive ventilator formulated under the guidance of improved B ultrasound single section method of antrum. The nutritional indexes [serum total protein (TP), albumin (Alb), prealbumin (PA) and hemoglobin (Hb)] of the two groups were compared before treatment and after 14 d of treatment. After treatment, the time to reach the target feeding amount, the length of ICU stay, and the length of ventilator use were compared. The incidences of EN related complications (reflux, abdominal distension, diarrhea, ventilator-associated pneumonia, and EN interruption) were calculated. t test was used for the measurement data and Chi-square test or Fisher exact probability method was used for the count data. Results　After treatment, the serum levels of TP, Alb, PA, and Hb in the experimental group were better than those in the control group [(59.14±7.22) g/L vs. (55.65±7.19) g/L, (38.09±7.18) g/L vs. (34.16±7.53) g/L, (192.56±22.18) mg/L vs. (182.73±22.45) mg/L, (107.11±3.22) g/L vs. (105.28±3.47) g/L] (all P<0.05). The time to reach the target feeding amount, the length of ICU stay, and the length of ventilator use of the experimental group were significantly shorter than those in the control group [(2.29±0.42) d vs. (3.68±0.47) d, (9.18±1.20) d vs. (11.25±1.23) d, (8.01±0.52) d vs. (10.17±0.55) d] (all P<0.001). The incidences of abdominal distension, diarrhea, ventilator-associated pneumonia, and EN interruption in the experimental group were 5.56% (2/36), 5.56% (2/36), 2.78% (1/36), and 8.33% (3/36), which were lower than 22.22% (8/36), 27.78% (10/36), 25.00% (9/36), and 27.78% (10/36) in the control group, with statistically significant differences (all P<0.05). Conclusion　Gastrointestinal nutrition guided by ultrasound monitoring can effectively reduce the incidence of EN complications in patients with traumatic brain injury undergoing invasive mechanical assisted ventilation, and improve their nutritional status and prognosis, which is worthy of popularization and application.

Key words: B-ultrasound guidance, Brain trauma, Mechanical ventilation, Enteral nutrition

摘要： 目的　探讨B超引导在脑外伤有创机械辅助通气患者肠内营养（EN）策略中的应用。方法　选取2019年11月至2021年5月入住连州市人民医院重症医学科（ICU）的脑外伤有创机械通气患者共72例，随机数字表法分为参照组（36例）和试验组（36例）。参照组男24例，女12例，年龄（46.28±7.64）岁；试验组男26例，女10例，年龄（47.07±7.22）岁。两组患者均于入院后24～72 h内留置鼻胃管行EN治疗，参照组采用传统根据临床经验制定的EN方案，试验组采用改良的B超胃窦单切面法为指导制定有创呼吸机的EN方案。比较两组患者治疗前及治疗14 d后营养指标［血清总蛋白（TP）、白蛋白（Alb）、前白蛋白（PA）、血红蛋白（Hb）］，比较治疗后达到目标喂养量的时间、ICU停留时间、呼吸机使用时间，并统计EN相关并发症（返流、腹胀、腹泻、呼吸机相关肺炎、EN中断）的发生率。计量资料应用t检验，计数资料应用χ²检验或Fisher确切概率法。结果　治疗后，试验组血清TP、Alb、PA、Hb水平均优于参照组［（59.14±7.22）g/L比（55.65±7.19）g/L，（38.09±7.18）g/L比（34.16±7.53）g/L，（192.56±22.18）mg/L比（182.73±22.45）mg/L，（107.11±3.22）g/L比（105.28±3.47）g/L］（均P<0.05）。试验组患者达到目标喂养量的时间、ICU停留时间、呼吸机使用时间均较参照组明显缩短［（2.29±0.42）d比（3.68±0.47）d，（9.18±1.20）d比（11.25±1.23）d，（8.01±0.52）d比（10.17±0.55）d］（均P<0.001）。试验组腹胀、腹泻、呼吸机相关肺炎及EN中断发生率分别为5.56%（2/36）、5.56%（2/36）、2.78%（1/36）、8.33%（3/36），均低于参照组的22.22%（8/36）、27.78%（10/36）、25.00%（9/36）、27.78%（10/36），差异均有统计学意义（均P<0.05）。结论　应用以超声监测为导向的胃肠营养可有效降低脑外伤有创机械通气患者EN并发症的发生率、改善患者营养状态及预后相关指标，值得推广与应用。

关键词: B超引导, 脑外伤, 机械通气, 肠内营养