摘要目的:评价床旁胃超声指导自发性脑出血患者肠内营养治疗的效果。方法:选取本院ICU自发性脑出血患者61例，年龄18~60岁，2002欧洲营养不良风险筛查评分≥3分，不能经口进食。均已接受全麻下去骨瓣减压或动脉瘤夹闭术。采用随机数字表法将患者分为2组：对照组( n＝30)和超声组( n＝31)。采用营养泵经鼻胃管连续输注标准整蛋白配方肠内营养制剂，对照组通过胃管负压盒评估胃残余量、残余物性状及肠鸣音以启动或调整肠内营养治疗；超声组通过超声下改良胃窦单切面法监测胃窦运动指数、胃残余量以启动或调整肠内营养治疗。记录肠内营养启动时间、达目标喂养量时间、96 h目标喂养达标情况、肠内营养中断发生情况、ICU住院时间及肠内营养治疗过程中腹腔内高压、误吸、腹泻、消化道出血、肺部新发感染的发生情况。 结果:与对照组比较，超声组肠内营养启动时间和达目标喂养量时间缩短，肠内营养中断率降低，96 h目标喂养达标率升高，误吸和肺部新发感染发生率降低( P<0.05)，ICU住院时间、腹腔内高压、腹泻、上消化道出血的发生率差异无统计学意义( P>0.05)。 结论:床旁胃超声指导自发性脑出血患者肠内营养治疗可提高治疗效果，且安全性更高。

abstractsObjective:To evaluate the efficacy of bedside gastric ultrasound in guiding enteral nutrition therapy in the patients with spontaneous cerebral hemorrhage.Methods:Sixty-one patients with spontaneous intracerebral hemorrhage in the intensive care unit (ICU) of our hospital, aged 18-60 yr, with the European malnutrition risk screening score in 2002 was ≥ 3, who could not eat orally, were selected.All patients received decompression or aneurysm clipping under general anesthesia.Patients were divided into 2 groups using a random number table method: control group ( n=30) and ultrasound group ( n=31). Nutrient infusion pump was used to infuse standard whole protein formula enteral nutrition continuously through a nasogastric tube.In control group, gastric residual volume, residual traits and bowel sounds were evaluated according to gastric drainage to start or adjust enteral nutrition treatment.In ultrasound group, the antral motility index and gastric residual volume were monitored by the modified antral single section method under ultrasound to start or adjust enteral nutrition treatment.The starting time of enteral nutrition, time to reach the target feeding amount, rate of reaching the target feeding standard within 96 h, interruption of enteral nutrition, duration of hospitalization in ICU, and occurrence of intraperitoneal hypertension, aspiration, diarrhea, gastrointestinal bleeding and new pulmonary infection during enteral nutrition therapy were recorded. Results:Compared with control group, the initiation time of enteral nutrition and time to reach the target feeding amount were significantly shortened, the interruption rate of enteral nutrition was decreased, the rate of reaching the target feeding standard within 96 h was increased, the incidence of aspiration and new pulmonary infection was decreased ( P<0.05), and no significant change was found in the duration of hospitalization in ICU and incidence of intraperitoneal hypertension, diarrhea and upper gastrointestinal bleeding in ultrasound group ( P>0.05). Conclusions:Bedside gastric ultrasound-guided enteral nutrition therapy can improve the therapeutic effect with higher safety in the patients with spontaneous intracerebral hemorrhage.