老年脓毒症病人肠系膜上动脉超声峰值收缩速度变异度与胃肠功能障碍评分的相关性

doi:10.3969/j.issn.1003-9198.2026.03.019

摘要/Abstract

摘要： 目的分析老年脓毒症病人肠系膜上动脉(SMA)超声峰值收缩速度(PSV)变异度与胃肠功能障碍评分的相关性及其对病人预后的预测价值。方法选取2022年10月至2025年3月南京市第一医院重症医学科收治的66例老年脓毒症病人作为研究对象,收集其基线临床资料以及入住ICU 1～3 d的SMA-PSV,并计算SMA-PSV变异度;收集病人入住ICU第3、7天胃肠功能障碍评分(GIDS);开展肠内营养期间,记录喂养不耐受(FI)发生情况;记录28 d死亡数、非ICU天数(ICU-free)、非机械通气天数(MV-free)、非连续肾脏替代治疗天数(CRRT-free)等数据。结果根据入组病人SMA-PSV变异度中位数将病人分为A组和B组,每组各33例。2组基线年龄、性别、BMI、APACHEⅡ评分、序贯器官功能衰竭评估(SOFA)评分,第1、2、3天SMA-PSV,CRRT-free以及28 d死亡率差异均无统计学意义(P>0.05)。2组第3、7天GIDS,ICU-free,MV-free以及FI发生率差异有统计学意义(P＜0.05或P＜0.01)。Spearman相关分析显示,SMA-PSV变异度与第3、7天GIDS呈负相关(r=-0.408、-0.425,均P＜0.01),与ICU-free、MV-free呈正相关(r=0.280、0.267,均P＜0.05)。ROC曲线分析显示,SMA-PSV变异度预测老年脓毒症病人发生FI及28 d死亡的AUC分别为0.807(P＜0.01)和0.731(P＜0.05)。结论老年脓毒症病人SMA-PSV变异度与第3、7天ICU-GIDS呈正相关,且SMA-PSV变异度对病人的预后具有较高的预测价值。

关键词: 脓毒症, 胃肠功能障碍评分, 肠系膜上动脉, 老年人, 超声峰值收缩速度, 喂养不耐受

Abstract: Objective To analyze the correlation between the peak systolic velocity (PSV) variability of superior mesenteric artery (SMA) and Gastrointestinal Dysfunction Score (GIDS) in the elderly septic patients, and to explore the predictive value of SMV-PSV variability on prognosis of the patients. Methods Sixty-six elderly septic patients admitted to Department of Critical Care Medicine, Nanjing First Hospital from October 2022 to March 2025 were enrolled in this study. The SMA-PSV values on the 1st, 2nd, 3rd day at Intensive Care Unit (ICU) were collected to calculate SMA-PSV variability. Baseline clinical data and GIDS on the 3rd and 7th day at ICU were also collected. The occurrence of feeding intolerance (FI) during enteral nutrition was recorded. The mortality rate of 28-day, ICU-free days, mechanical ventilation (MV)-free days, and continuous renal replacement therapy (CRRT)-free days were also documented. Results Patients were divided into two groups based on the median SMA-PSV variability, with 33 cases in each group. There were no statistically significant differences between the two groups in age, sex, body mass index, Acute Physiology and Chronic Health Evaluation score, Sequential Organ Failure Assessment score, SMV-PSV values from the 1st day to the 3rd day, CRRT-free days, and 28-day mortality (P>0.05). There were significant differences in GIDS on the 3rd and 7th day, ICU-free days, MV-free days, and the incidence rate of FI between the two groups (P<0.05 or P<0.01). Spearman correlation analysis showed that SMA-PSV variability was negatively correlated with GIDS on the 3rd and 7th day (r=-0.408, -0.425, all P<0.01), and positively correlated with ICU-free days and MV-free days (r=0.280, 0.267, P<0.05). Receiver operating characteristic (ROC) curve analysis indicated that the areas under the curve of SMA-PSV variability for predicting FI and 28-day mortality were 0.807 (P<0.01) and 0.731 (P<0.05), respectively. Conclusions SMA-PSV variability is associated with GIDS on the 3rd and 7th day at ICU, and could be a valuable predictor for prognosis in the elderly septic patients.

Key words: sepsis, Gastrointestinal Dysfunction Score, superior mesenteric artery, aged, peak systolic velocity, feeding intolerance

中图分类号:

R 631

阚小华, 余春璇, 徐淮金, 叶梓语, 祁萍. 老年脓毒症病人肠系膜上动脉超声峰值收缩速度变异度与胃肠功能障碍评分的相关性[J]. 实用老年医学, 2026, 40(3): 320-324.

KAN Xiaohua, YU Chunxuan, XU Huaijin, YE Ziyu, QI Ping. Correlations between the peak systolic velocity variability of superior mesenteric artery and Gastrointestinal Dysfunction Score in elderly septic patients[J]. Practical Geriatrics, 2026, 40(3): 320-324.

参考文献

[1] EVANS L, RHODES A, ALHAZZANI W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021[J].Intensive Care Med, 2021, 47(11): 1181-1247.
[2] PERNER A, CECCONI M, CRONHJORT M, et al. Expert statement for the management of hypovolemia in sepsis[J]. Intensive Care Med, 2018, 44(6): 791-798.
[3] GUO C, DONG G, LIANG X, et al. Epigenetic regulation in AKI and kidney repair: mechanisms and therapeutic implications[J]. Nat Rev Nephrol, 2019, 15(4): 220-239.
[4] REINHART K, DANIELS R, KISSOON N, et al. Recognizing sepsis as a global health priority—a WHO resolution[J]. N Engl J Med, 2017, 377(5): 414-417.
[5] 米元元, 黄培培, 董江, 等. 危重症患者肠内营养不耐受预防及管理的最佳证据总结[J]. 中华护理杂志, 2019, 54(12): 1868-1876.
[6] 中国研究型医院学会. 脓毒症诊断与治疗规范(T/CRHA022-2023)[EB/OL]. (2023-08-22) [2025-08-01]. https: //www.ttbz.org.cn/StandardManage/Detail/88481/.
[7] REINTAM BLASER A, PADARM, MÄNDUL M, et al. Development of the Gastrointestinal Dysfunction Score (GIDS) for critically ill patients-A prospective multicenter observational study (iSOFA study)[J]. Clin Nutr, 2021, 40(8): 4932-4940.
[8] REINTAM BLASER A, MALBRAIN M L N G, STARKOPF J, et al. Gastrointestinal function in intensive care patients: terminology, definitions, and management. Recommendations of the ESICM Working Group on Abdominal Problems[J]. Intens Care Med, 2012, 38(3): 384-394.
[9] 陈国强, 钱睿哲. 病理生理学[M]. 10版. 北京: 人民卫生出版社, 2024:250-254.
[10] 潘春熹, 陈万, 吕立文, 等. 老年脓毒性休克患者急性胃肠道损伤超声表现及相关性研究[J]. 临床急诊杂志, 2020, 21(4): 261-266.
[11] 潘红, 蔡英华, 金科, 等. 基于重症超声监测胃残留量的肠内营养方案在肺移植患者中的应用[J]. 中华现代护理杂志, 2019, 25(9): 1113-1116.
[12] 傅园花, 郭莉娟, 葛国平. 床旁超声监测胃残余量对机械通气患者肠内营养耐受性的影响[J]. 中国中西医结合急救杂志, 2019, 26(3): 326-328.
[13] HAMADA S R, GARCON P, RONOT M, et al. Ultrasound assessment of gastric volume in critically ill patients[J]. Intensive Care Med, 2014, 40(7): 965-972.
[14] 曹岚, 叶向红, 李君, 等. 床旁超声监测胃残余量在神经外科重症患者肠内营养中的应用[J]. 中华医学杂志, 2017, 97(9): 675-678.
[15] 邓岩军, 吴雪梅, 谢红, 等. 超声测定胃排空功能指导重症机械通气患者肠内营养的临床应用[J]. 中华老年多器官疾病杂志, 2016, 15(7): 533-536.