KR20040104158A - Measuring Gastrointestinal Parameters - Google Patents

Abstract

The present invention relates to a method of measuring dietary formula concentration, gastric residue volume and gastric contents in the stomach.

Description

Measuring method of gastrointestinal parameter {Measuring Gastrointestinal Parameters}

The present invention relates to a method for measuring the concentration of dietary formula of the contents of the stomach, the residual volume of the stomach, the volume of the dietary formula in the stomach and the volume of gastric juice in the stomach.

Enteral nutrition has generally been preferred over parenteral nutrition due to low cost, low complexity, and efficient conservation of internal organ structure and function. Many patients are burdened with nasogastric tube feeding, and unbearable phenomena continue to occur, including nausea, vomiting, bloating, and aspiration. The residual volume of gastric juice obtained by the nasogastric tube aspiration method is widely used to measure tolerance and gastric emptying. Higher elevations of the gastric residue volume are associated with refusal to gastric feeding and potential risks of vomiting and pneumonia. It is known that the value of the gastric residue volume increases when infused into a patient to feed up through the nose within a typical range of 75-500 mL. However, many nurses, nutritionists, and surgeons use the volume of aspirated stomach residues as orthodox and stop supplying the intestinal supply regardless of the clinical phenomenon if the value exceeds the desired value.

However, the existing gastric residual volume does not take into account the fact that the fluid accumulated in the gastrointestinal tract of the nourishing patient through the nasal tract contains not only the formula itself, but also the swallowed saliva and stomach secretions. Value is not present. The volume of the stomach residues alone cannot distinguish additional endogenous secretions in patients that effectively empty the volume of external feedstock. Therefore, estimating the gastric emptying state based solely on the volume of gastric residues inhaled causes inaccuracies due to the limitation that the gastric contents cannot be inhaled completely. In addition, existing methods of using inhaled residue volumes are insensitive and have the disadvantage that the components of the intestinal formulas that follow are indistinguishable from naturally occurring endogenous secretions.

The present invention has been made to solve the above problems, and monitors the concentration of dietary formula, the actual volume of stomach residues and the volume of the contents of the stomach in the stomach for patients receiving nutrition through the nasal tube It is intended to provide a way to.

Figure 1 shows the mathematical basis of the calculation of dietary formula concentration. Since the Brix value of the polymer diet is linearly related to the diet formula concentration (R2 = 0.99), the Brix value makes it possible to obtain a dietary formula concentration calculation equation.

2 shows the mathematical basis of the above residue volume calculation. Before diluting the water, the value of the above residue volume is calculated from the calculated GRV Vol. It was set to 1, the% value of the polymer diet of the maximum intensity was set to% Conc.1, and the brix value of the above contents was set to BV1. After dilution of the gastrointestinal tract with 30 mL water, the volume of the stomach was changed to Vol. 2, the% value of the polymer diet of maximum intensity was set to% Conc. 2 and the brix value of the above contents was set to BV2.

Figure 3 shows the mathematical basis of the equation and the calculation of dietary formula volume in the stomach.

Figure 4 observes the continuous nasogastric tube feed by determining residue volume measurements and brix values.

Referring to the configuration of the present invention in detail as follows.

How to measure the concentration of dietary formula

The present invention provides a method for determining the percent concentration of dietary formula of gastrointestinal contents, i) injecting a dietary formula into the stomach, ii) gastrointestinal tract over an appropriate time after measuring the infusion and their brix values. Obtaining the contents, i) Obtaining the percent concentration of the dietary formula in the gastrointestinal contents by the formula of percent concentration of the dietary formula = Brix value / slope value, where the slope value represents the concentration series of the dietary formula. Dilution of dietary formulas in order to obtain a formula, and measuring the brix value of the resultant concentration of the dietary formula, obtained by regression analysis using the resultant concentration and brix value above)

A preferred embodiment of the method according to the invention is discussed with reference to FIG. 1.

According to the present invention, any dietary formula may be used in the present invention. Preferably, the dietary formula according to the present invention is a dietary formula for nutrition through the tube, more preferably a liquid dietary formula.

According to the invention, any concentration range of the dietary formula can be monitored by the method according to the invention. That is, even a 100% dietary formula can be monitored by a refractive index meter.

It is surprisingly found that the percent concentration of dietary formulas of gastrointestinal substances is not affected by bio secretions, pH values, temperature or the duration of dietary formulas in the stomach. In addition, the percent concentration of this dietary formula is linear to the Briggs value. Percent concentrations of dietary formulas of substances in the gastrointestinal tract can also be determined by the formula Percent concentration of dietary formula = Brix value / slope value, where the slope value can be obtained by regression analysis known in the art.

Method of measuring gastrointestinal residue volume

The present invention provides a method for measuring the volume of gastrointestinal residue volume, i) determining the brix value of the gastrointestinal residue volume to obtain BV1, ii) said gastrointestinal residue to obtain mixed gastrointestinal contents. Adding an appropriate volume of water to the volume, i) injecting the mixed gastrointestinal contents into the stomach, i) aspirating the resulting gastrointestinal contents from the stomach, i) the resulting gastrointestinal contents to obtain BV2 A method of measuring the volume of gastrointestinal residues consisting of obtaining the volume of gastrointestinal contents obtained by the step of obtaining the brix value of (iii) (BV1 × volume of added water) / (BV1-BV2) do.

2 shows a preferred embodiment of the method according to the invention.

According to the present invention, any suitable technique or apparatus may be used for the measurement of brix values. Preferably the brix value can be measured by a refractive index meter.

According to the present invention, "gastrointestinal residual volume" refers to a dietary formula, bio secretions such as gastrointestinal secretions or saliva, and mixtures thereof.

According to the present invention, "suitable volume of water" refers to water used to dilute the gastrointestinal contents. Preferably, a volume of water having a volume of about 10 mL to 500 mL is suitable.

Surprisingly, it is shown that Brix value measurement can be used as a new tool to measure the calculated gastric residue volume. The brix value of gastrointestinal residual volume is measured to obtain BV1. The resulting gastrointestinal contents are added with the appropriate volume of water to obtain the mixed gastrointestinal contents. The resulting mixed gastrointestinal contents are injected into the subject's stomach. The gastrointestinal contents are then sucked out again from the patient's stomach into the inhaler and again, the brix value of the gastrointestinal contents is measured to obtain BV2. The formula for obtaining the volume of the gastrointestinal contents is derived from the following formula.

BV1 × volume of gastrointestinal contents before dilution = BV2 × (volume of gastrointestinal contents before dilution + volume of water added)

BV1 × Volume of Gastrointestinal Content = BV2 × Volume of Gastrointestinal Content + BV2

BV1 × Gastrointestinal Content-BV2 × Gastrointestinal Content = BV2

Volume of gastrointestinal contents before dilution × (BV1-BV2) = BV1

Gastrointestinal contents = (BV2 × volume of water added) / (BV1-BV2)

In conclusion, the volume of the gastrointestinal contents is obtained by the following equation. "(BV2 × volume of water added) / (BV1-BV2)"

Determination of remaining dietary formula volume and gastric juice volume in the stomach

The present invention provides a method for measuring the remaining amount of dietary formula remaining in the gastrointestinal tract, which is obtained by multiplying the calculated gastric residue volume by the maximum strength of the dietary formula.

According to the present invention, as discussed above, the calculated gastrointestinal residue volume can be obtained from a method of measuring the gastrointestinal residue volume of the present invention. According to the invention, any dietary formula can be used in the method of the invention. Preferably, this dietary formula according to the present invention is a dietary formula for nutrition through the tube, more preferably a dietary formula of polymer. The formula volume remaining in the gastrointestinal formula can be calculated by the following equation. "Volume Remaining in the Stomach = Calculated Gastrointestinal Residue Volume x% Value of Maximum Strength of Dietary Formula" A preferred embodiment of the method according to the invention is addressed in the description of Figure 3 below.

The present invention further provides a method for measuring gastric juice (gastric acid) volume in the gastrointestinal tract, by subtracting the volume of dietary formula remaining in the gastrointestinal tract from the gastrointestinal residue volume. The remaining dietary formula volume in the stomach can be obtained as discussed above.

The actual gastrointestinal residue volume is determined by a dynamic measurement (dynamic balance) between the input from the aspirated formula, the internal secretions and the emissions related to the gastric emptying time. On average, internal secretions consist of 1500 mL of saliva and 3000 mL of gastric juice. Therefore, developing a method for determining the total volume of contents in the gastrointestinal tract and a system for distinguishing the exact volume of the components of the formula in a mixed solution of the contents of the stomach play an important role in treating patients fed by the tube. The above secretion was measured using the following equation.

Volume of gastric secretions (ie gastric acid) = calculated volume of gastric residues-volume of dietary formula remaining

Use

The following facts were found by this invention. 1) The dietary range of nutrients (carbohydrates, proteins, fats) can be observed by a refractometer. 2) The bric value is a linear increase function of the nutrient concentration in the solution. 3) Brix values are closely related to dietary formula concentrations regardless of pH, temperature and type of solution. Taken together, the present invention shows that the Brix values can be used for medically and for studying dietary formula concentrations. Therefore, it can be used in the medical practice of evaluating dietary formulas during storage, preparation and administration.

The invention is used to measure the brix value of the gastric dose to monitor both the gastric residue volume and the amount of food in a patient receiving nutrition through the nasal tract. As can be seen from this invention, the measurement of brix values of gastric juice will be a new tool for the observation of gastric emptying in patients receiving nasal nutrients, providing supplemental information on the customary use of the inhaled gastric residue volume.

Brix value measurements of various dilutions of the polymerization diet in the present invention have less variability in vitro. The simple method of the present invention enables clinical measurements with a high degree of reproducibility. On the other hand, saliva and gastric secretions have little dissolved material and therefore have a corresponding low brix value close to distilled water. It is therefore possible to determine which gastric dose of a patient receiving a polymer component is mainly composed of a dietary formula or digestive fluid.

The application of Brix value measurements of the contents of the gastrointestinal tract would be usefully supplementing the use and interpretation of the gastric residue volume with respect to the handling of medical patients, especially those who are nourished through the nasal tract.

Residual volume of the stomach is determined with respect to the kinetic equilibrium of what comes in from the stomach (the endogenous saliva and exogenous formula with gastric juice added) and the exit (gastric drainage). Low brix values (particularly if there is a normal reduction following lump infusion) indicate low levels of nutrient fluid remaining and include adequate drainage of nutrient fluids from the stomach. This is confirmed by using the dilution technique and the change in brix values to determine the calculated volume of the above residue and the unit volume of the remaining nutrient solution.

Patients with low gastric residue volume are associated with low food stagnation (low brix value) and are interpreted to indicate that the formula is properly excreted and there is no stagnation in the stomach.

At low gastric residue volumes, the risk of aspiration is expected to be small and the patient will be understood as tolerating feeds. On the other hand, high values of gastric residue volume associated with high food stagnation indicate increased volume of gastric contents as a result of nutrients retained in the stomach and true feeding intolerance in delayed gastric emptying. However, patients with low gastric residue volume but high food stagnation may be interpreted as having evidence of gastric dysmotility. In the case described above, the low gastric residue volume is a false negative screening monitor caused by the fact that the tip of the feed tube is not in gastric fluid or the tip of the feed tube is fixed to the gastric mucosa layer. Indicates. In patients with high residue volumes, low food stagnation by some Brix value determinations gives conviction that the nutrient solution has been properly excreted from the stomach. High residue volumes indicate a false positive screening monitor. Feeding may continue as long as a detailed medical evaluation continues.

The biggest advantage of the refractometer is its low cost and ease of use. The advantages of a refractometer are in two ways. The small change in brix values over several hours after the solid feeding confirms that the measurement of gastric emptying status is not good using conventional suction of gastric residues. Second, the dilution technique of the refractometer will provide a double review and confidence in the volume of the actual gastric residue and the volume of enteric nutrients remaining in the stomach. Continuous Brix value measurements will ultimately be applied to patients with nausea, vomiting and early satiety as a simple medical diagnosis of gastric emptying. Brix value measurements will be used in refractometers for monitoring and medical applications of food content remaining in the stomach after further study and validation.

The following examples are provided for illustration and not limitation.

Example 1 Use of Briggs Value to Determine Concentration of Dietary Formulas in Gastric Fluids

Materials and methods

Brix values of nutrients such as minerals, vitamin mixtures, carbohydrates, proteins, fats, and polymeric diets are determined by a refractometer (N.O.W 507-1, Nippon Optical Works; Tokyo, Japan). Mineral solution (Ringer's solution) is obtained from YF Chemical Co., Ltd. (Taipei, Taiwan) and consists of sodium chloride (8.6 mg / ml), potassium chloride (0.3 mg / ml) and calcium chloride (0.33 mg / ml) It is. Vitamins (Lyo-povigen, non-curable vitamin mixtures) were also obtained from YF Chemical Co., Ltd. (Taiwan), vitamin A palmitate (12 IU / ml), vitamin D2 (1 IU / ml), Vitamin E (0.005 IU / ml), Vitamin C (0.5 mg / ml), Vitamin B1 (0.05 mg / ml), Vitamin B2 (0.01 mg / ml), Vitamin B6 (0.015 mg / ml), niacinamide ( 0.1 mg / ml), d-panthenol (0.025 mg / ml). Carbohydrates (Carb-aid, Corn starch) and proteins (Wheyaid, lacroalbumin) are purchased from the Nutritec-Enjoy Nutrition Center. Taiwan.Fat (Intralipid) was obtained from Frenius Kabi AB, Uppsala, Sweden. Full strength polymeric diet (Osmolite HN, Ross, OH, USA) contains carbohydrate (17 g / 100ml), protein (5.3 g / 100ml), and fat (4.1 g / 100ml) do.

Statistical analysis

Results are shown as mean ± SEM. The linear regression analysis followed by the correlation coefficient is used to evaluate the relationship between Briggs values and dietary formula concentrations. The error is considered statistically significant when P <0.05.

result

Brix value of nutrients

The Briggs values and dietary formulas of nutrients are listed in Table 1. Distilled water, minerals and vitamins contain less soluble substances and correspondingly have lower brix values of 0 ± 0, 1.2 ± 0.1 and 0.4 ± 0.1, respectively. On the other hand, carbohydrate (17 g / 100ml), protein (5.3 g / 100ml), fat (4.1 g / 100ml), and maximum strength dietary polymers have high concentrations of dissolved nutrients and correspondingly 12.1 ± 0.6 and 6.5 ± 0.1, respectively. , 6.0 ± 0.1. It has a high brix value of 23.5 ± 0.1.

The molar refractive index in the solution of mixed nutrients was investigated. Three concentrations (50%, 100%, 200%) of each pure brix value of the nutrient are additional in the mixture. Table 2 shows the brix values of pure nutrients (such as carbohydrates, proteins, fats) and mixtures thereof. Three dilutions of carbohydrate, protein and fat (50%, 100% and 200% of the starting concentration) are made from distilled water. The brix value is a linear increase function of the concentration of the solute, regardless of whether the solute is carbohydrate, protein or fat.

In nutrient solutions consisting of any combination of carbohydrate (17 g / 100ml), protein (5.3 g / 100ml), fat (4.1 g / 100ml), the Briggs value is also a linear increase function of the composition concentration. For example, a mixture of carbohydrate (17g / 100ml) and protein (5.3 g / 100ml) has a brix value of 19.2 ± 0.1, carbohydrate (17g / 100ml), protein (5.3g / 100ml), fat (4.1 g / 100 ml) has a brix value of 23.0 ± 0.1 which is close to the brix value (23.5 ± 0.1) of the maximum strength dietary polymer.

The brix values of nutrients at various pH and temperatures in Table 3 show the effect of pH on brix values of sequentially diluted dietary polymer formulas. Invariably, the brix values correlate with the concentration of dietary polymer formula at each pH (p <0.001). However, the brix values of dietary polymer formulas are lower at pH 1 and 4 than at pH 7 and 8. The decrease in brix value would be related to protein denaturation in the acid solution. Table 4 shows the effect of temperature on Briggs values of sequentially diluted polymeric dietary formulas. Briggs values correlate with the concentration of dietary formula at all observed temperatures (p <0.001).

The brix values of the polymerization diet in the gastric juice of the fasting in Table 5 show the effect of gastric juice dilution with respect to the brix value of the polymerization dietary formula. Brix values of dietary polymers in fasting gastric juice were 5, 30, 120 and 240 minutes, respectively. Briggs values are closely related to dietary polymer concentrations diluted in fasting gastric juice with little change at each time (R2 <0.98). Therefore, the dietary polymer formula concentration at the above dose can be predicted based on a linear regression equation: Brix value = 0.24 / (% maximum strength polymerization diet). For example, the brix values of 6.0 and 12 of the above doses correspond to the maximum strength polymerization diet concentrations of 25% and 50%.

Example 2 Observation of Solid Nutrition Feeded Through the Nasal Cavity by Determination of Briggs Value of the Gastric Capacity

Materials and methods

All BV measurements are made using a refractometer with a hand held Briggs scale in the range 0-32 and incremented by 0.2. The refractometer is calibrated with distilled water prior to each measurement. One or two drops of the sample solution are placed in a designated window for observation, and all measurements are made at room temperature using natural light. In this way the concentration of solids dissolved in the solution is measured in the clinic of each sample.

Brix values of dietary polymers (Osmolite HN, Abbott Laboratories, Columbus, Ohio) and three solutions (distilled water, fasting saliva, gastric juice) are determined by a refractometer. Sequential dilutions of the polymer nutrient solution (100%, 50%, 25%, 12.5%, 6.2%, and 0%) are made of three solutions (distilled water, fasting saliva, gastric juice). Briggs values are measured in vitro by each dilution of polymerized nutrient solution.

Patients receiving solid nutrients through the nasal tract are suitable for this study. All subjects are nourished by the highest strength dietary polymer through 14 French Nasal Tubes. The composition of the dietary polymer is 16.7% protein, 54.3% carbohydrate, and 29.0% fat. The required amount of calories can be calculated using the Harris-Benedict equation. A total of 250 mL of dietary polymer is administered by solid infusion every 3-6 hours within 24 hours prior to study. The residue volume of the aspirated stomach is obtained by aspiration of the feeding tube prior to the supply of each solid nutrient. The residue volume of the aspirated stomach is obtained first in the supine position and then in the right decubitus position. Following the preliminary period of this observation, patients are randomly divided into two groups based on the customary use of the aspirated gastric residue volume. Patients with a low stomach residue volume (<75 mL) are classified as group 1 and patients with a high stomach residue volume (> 75 mL, in at least two cases) are classified as group 2. A total of 25 subjects were group 1 (age: range = 59-84, mean ± SD = 75.9 ± 6.6 years) and 18 subjects were group 2 (age: range = 44-79, mean ± SD = 70.6 ± 10.6 years) Was recruited as. Consent was obtained from all patients (or their representatives) before participating in the study.

All gastric juice remaining after fasting overnight was aspirated from the stomach through a nasal nutrient tube using a 60 mL syringe. Thereafter, all subjects received a lump injection of a 250 mL polymerization diet. Immediately after feeding, attempts were made to thoroughly mix the food contents in the stomach by suction and reinjection of three nasal nutrient tubes with a 60 mL syringe.

Continuous BV determinations were made at 0, 30, 60, 120, 180 minute intervals with a 2 mL sample of gastric contents. At 180 minutes any liquid remaining in the stomach was aspirated. Its volume was recorded as the residue volume of the stomach that was aspirated, brix value measurements were made and the contents injected back up.

Since brix values of dietary polymers have a linear increase relationship with dietary formula concentrations (R2 = 0.99), we can derive an equation for calculating dietary formula concentrations (Figure 1). Due to this high degree of correlation, the percent concentration of the nutritional diet (% maximum strength polymerization diet) at any dilution can be calculated from the measured brix values.

The customary use of the gastric residue volume obtained by aspiration through a syringe is not accurate and reliable for measuring the true volume of the contents at any point in time. A water dilution diagnostic was designed to calculate the above residue volume (Figure 2). An additional 30 mL of distilled water was injected to dilute through the nasal nutrient tube. The contents above were again thoroughly mixed (using 60 mL syringe, 3 times filling and emptying) and 2 mL of sample was obtained for final brix value determination. Water dilution diagnostics (determining brix values before and after injection of 30 mL of distilled water) use the relationship between the% concentration of nutrient solution at any dilution and the measured brix values as shown in Figure 1. It is then used to calculate the actual volume of the contents (Figure 2) and the unit volume of nutrient solution remaining in the stomach (Figure 3).

Before dilution with water, the unknown volume of gastric residue is Volume 1 (Vol. 1), the% value of the maximum strength dietary polymer is% concentration 1 (Conc. 1), and the brix value of the gastric contents is Set to BV1. After 30 mL of water dilution in the stomach, the volume of the stomach is placed in Volume 2 (Vol. 2), the% value of the maximum strength dietary polymer is% concentration 2 (Conc. 2), and the brix value of the gastric contents is BV2. Therefore, the residue volume (Vol. 1) above (Figure 2) can be calculated by the following derived equation.

1. Since the calories of nutrient solution does not change by dilution of distilled water from above, the calories of gastric nutrient solution is the same before and after water dilution. (Equation 3a: Vol. 1 (kcal) = Vol. 2 (kcal))

2. Gastric nutrient calories = total gastric volume × maximum strength dietary polymer% value, substituting this in 3b: Vol.1 ×% Conc.1 = Vol.2 ×% Conc.2

Vol. 2 = Vol. 1 + 30 mL, substituting this for 3c: Vol. 1 x% Conc. 1 = (Vol. 1 + 30 mL) x% Conc.

4. Substituting BV ÷ 0.24 from the% maximum strength nutrient concentration from Figure 2 gives the following equation: (3d: Vol. 1 x (BV1 ÷ 0.24) = (Vol. 1 + 30 mL) x (BV2 ÷ 0.24)).

5. Multiply both sides by 0.24 to get Equation 3e. (3e: Vol. 1 × BV1 = (Vol. 1 + 30 mL) × BV2).

6. The calculated residue volume (GRV) is obtained by this formula. (3f: Vol. 1 = (BV2 x 30 mL) ÷ (BV1-BV2)).

Formulas were calculated to calculate the volume of nutrients remaining in the stomach to determine if the volume of the stomach residues was high in dietary formulas or gastric juices. : Nutrient remaining in the stomach =% concentration at 180 minutes × gastric residue volume calculated at 180 minutes (Figure 3).

The results are shown as mean ± SEM. Students' t-tests are used to assess differences in outcomes between Group 1 and Group 2 patients. P values less than 0.05 are considered statistically significant.

result

The highest strength dietary polymer has a high concentration of dissolved nutrients, so it can be seen that it has a high average BV value of 23.2 ± 0.3. Distilled water, saliva, and fasted gastric juice had significantly lower mean BV values, corresponding to 0 ± 0, 1.3 ± 0.4, and 1.9 ± 0.6, respectively.

Table 1 shows the average BV values of the dietary polymer dissolved in three different solutions in a test tube (distilled water, saliva, and gastric juice). The average brix value of dietary polymers is linearly related to dietary formula concentrations in water (R ² = 0.99). The results show that, regardless of whether the diluent is saliva (R ² = 0.98) or fasting gastric juice (R ² = 0.98), the average brix value of successive dilutions of dietary polymers is comparable (Table 1).

TABLE 1.The Brix Values for the polymeric diet diluted with different solutions in vitro % Full strength of polymeric diet (Osmolite HN) Solution 0 6.2 12.5 25 50 100 Distilled water 0 ± 0 2.1 ± 0.4 3.5 ± 0.8 6.0 ± 0.9 12.2 ± 0.8 23.2 ± 0.3 Saliva 1.3 ± 0.4 2.2 ± 0.6 4.4 ± 0.6 7.3 ± 0.7 12.4 ± 0.9 23.2 ± 0.5 Gastric juice 1.9 ± 0.6 4.4 ± 1.4 5.4 ± 1.3 7.8 ± 1.4 13.3 ± 1.2 23.2 ± 0.4 Results are presented as mean values for six separate determinations ± SEM. TABLE 2.Serial Brix values and gastric residual volumes (GRVs) for patients in group 1 (low GRVs) Brix value of gastric juice Residual volume (mL) Patient no. 0 min 30 min 60 min 120 min 180 min Aspirated GRV Calculated GRV Formula remaining One 13.9 12.2 5.3 8.5 9.6 30 23 9 2 22.3 14.3 14.3 14.3 14.8 0 3 2 3 23.4 19.5 13.7 10.3 11.6 70 115 56 4 22.6 14.6 13.2 12.4 10.1 10 31 13 5 11.9 10.4 8.2 4.6 4.9 10 215 44 6 21.5 13.5 12.3 9.4 8.5 30 - - 7 22.4 13.2 12.5 7.2 8.7 20 - - 8 23.3 20.4 14.3 10.3 9.1 79 68 26 9 14.5 11.3 9.4 5.4 5.3 32 92 20 10 12.9 10.6 8.3 5.3 4.3 12 185 33 11 13.3 9.2 8.4 5.0 4.2 10 - - 12 14.8 10.3 8.3 6.4 4.8 15 - - 13 17.6 12.3 10.4 7.4 4.6 70 62 12 14 17.7 12.4 9.7 7.5 4.4 78 80 15 15 14.8 10.3 8.3 6.4 4.8 15 - - 16 20.2 18.4 15.3 4.6 3.5 8 45 7 17 17.2 14.5 10.2 4.4 2.6 32 - - 18 16.5 12.5 9.3 3.6 2.5 30 - - 19 16.4 12.4 9.3 3.5 2.3 5 - - 20 22.3 14.4 10.0 5.4 2.9 9 16 2 21 22.3 21.2 20.5 3.3 2.7 One - - 22 20.9 17.4 14.3 3.7 2.3 5 47 4 23 26.2 16.3 14.1 12.3 2.0 8 30 3 24 23.8 12.7 10.6 4.3 1.5 0 15 One 25 26.0 15.6 15.2 13.4 1.3 0 48 3 Mean ± SEM 19.6 ± 1.0 14.0 ± 0.8 11.4 ± 0.8 7.1 ± 0.8 5.1 ± 0.9 * 18 ± 5 * 67 ± 15 * 6 ± 2 * p <0.05 from mean value group 1 versus group 2

Immediately after ingestion of 250 mL of the dietary diet mass, the average BVs value of the gastric contents in vivo is the mean for the polymerization formulas made in vitro for both Group 1 and Group 2 (19.6 ± 1.0 and 20.3 ± 1.1, respectively). 23.2 ± 0.3). This decrease in brix values is mainly due to the dissolution effects of physiological endogenous gastric juice that remained in the stomach at the time of ingestion.

Continuous changes in brix values of the stomach contents in the two groups after ingestion of solid dietary polymers are shown in Tables 2 and 3. The mean continuous brix value after ingestion of solids decreased in both groups. For patients in group 2, the decrease was small, for example, for 180 minutes of group 2, patients with a significantly higher mean brix value of the stomach contents were found than for the same patients in group 1. (10.1 ± 0.7 and 5.1 ± 0.9, and p <0.01, respectively)

Tables 2 and 3 also show that in the case of 180 minutes, the volume of aspirated stomach residues is much higher for patients in group 2 than for patients in group 1 (72 ± 12 and 18 ± 5 mL, respectively, and p <0.01)

TABLE 3.Serial Brix values and gastric residual volumes (GRVs) for patients in group 2 (higher GRVs) Brix value of gastric juice Residual volume (mL) Patient no. 0 min 30 min 60 min 120 min 180 min Aspirated GRV CalculatedGRV Formula remaining One 16.4 14.5 11.2 11.3 12.3 15 89 46 2 13.4 12.4 12.4 8.5 9.3 30 26 10 3 17.8 14.1 12.4 13.4 12.3 35 138 71 4 22.1 19.2 16.3 14.4 14.4 190 197 118 5 19.2 18.2 16.2 15.1 11.2 37 82 38 6 23.3 19.2 16.5 15.5 13.0 210 165 89 7 20.2 19.6 18.2 15.3 10.6 47 215 95 8 29.1 25.0 22.1 15.5 14.2 65 79 47 9 29.0 24.5 20.3 14.7 14.2 55 55 33 10 23.1 19.3 13.3 10.2 11.4 70 125 60 11 23.3 17.2 14.4 12.3 11.2 74 104 49 12 12.5 9.3 7.7 6.2 5.5 65 108 25 13 21.2 17.4 13.7 9.3 8.6 60 93 33 14 21.5 18.4 14.6 10.2 8.2 70 68 23 15 14.2 12.5 8.8 6.7 5.1 75 - - 16 22.2 18.5 12.2 8.6 5.3 85 - - 17 15.2 14.2 12.2 8.3 9.1 40 48 18 18 22.4 17.2 10.2 8.8 6.7 65 - - Mean ± SEM 20.3 ± 1.1 17.3 ± 1.0 14.0 ± 0.9 11.3 ± 0.8 10.1 ± 0.7 * 72 ± 12 * 106 ± 14 * 50 ± 8 * p <0.05 from mean value group 1 versus group 2

The mean calculation of the volume of stomach residues shows that the patients in Group 2 are much higher than those in Group 1 (106 ± 14 and 67 ± 15 mL, and p <0.05). Specific volume formulas corresponding to 180 minutes in both groups, by using the final brix value (before dissolved in water) along with the calculation of the residual residue volume to determine the% concentration of the dietary polymer of maximum strength. This was determined.

As shown in Tables 2 and 3, by using the refractive index method in conjunction with the traditional usage of gastric residue volume, 4% (1/25) of patients in group 1 who had gastric dyskinesia had a low gastric residue volume. (20% of the volume of the first 250 mL mass of the formula residue for> 180 minutes). The use of refractive index measurements with gastric residue volume helped to confirm that 72% (13/18) of patients in group 2 with high gastric residue volume had emptyed the stomach sufficiently (<250 mL of formula residue first) 20% of the volume).

Example 4 Feeding Through Continuous Nasal Trachea: Observation by Briggs Value and Traditional Gastric Residue Volume

Materials and methods

After 24 hours of observation, 36 patients in continuous intestinal feeding with maximum strength dietary polymer (Osmolite HN) were introduced into the study, depending on the pattern of volume of aspirated stomach residues applied during the observation period. Divided into groups. Patients with low values of aspirated gastric residue volume (<75 mL) were assigned to group 1, whereas patients with high values of aspirated gastric residue volume (> 75 mL at least two or more times) were assigned to group 2 Was assigned to Aspirated stomach residue volume was obtained by feeding tube aspiration with a 60 ml enema, initially lying flat and then lying sideways to the right. Initially, all gastric contents are aspirated, the volume is recorded (volume of gastric residues aspirated), the Brix value is measured by the refractive index method, and the contents are slowly soaked by 30 mL of added water. Is dissolved by lifting. Subsequently, a small amount is aspirated out again, and the Brix value measurement is repeated. After three hours, this whole process is repeated twice.

Brix values are measured by using a manual refractometer that can read brix scales from 0 to 32 up to 0.2 increments. The refractive index meter is calibrated with distilled water before each measurement. Place one or two drops of sample liquid in the designated window for observation using sunlight at room temperature. In this way, the concentration of soluble solids in solution is measured for each sample in the clinic.

The brix value ratio, an indirect measure of the amount of formula remaining in the stomach, can be calculated by dividing the brix value before dilution by the brix value after dilution. The estimate of the actual volume of gastric contents remaining in the stomach (FIG. 3), or the calculated volume of the gastric residue (FIG. 2) was determined by the following formula: Brix value before dilution × calculated volume of stomach stomach residues = dilution Post Brix value × (calculated volume of stomach residue + 30 ml) (Figure 2). The specific component of this residual volume, consisting of the formula, can be estimated from the following equation: The volume of the dietary formula remaining in the stomach = the calculated volume of the stomach residue × [(Brix value 0.24) / 100] (Figure 3) ).

The results are shown as mean ± SEM. Student's t-test was used to assess the difference in outcomes between patients in Group 1 and Group 2. P values less than 0.05 were considered statistically significant.

result

None of the patients in the group showed symptoms of vaginal nausea, vomiting, inhalation, or difficulty in endurance when fed by the intestinal tract. Table 1 shows the data of gastric residue volume in patients in Group 1. Based on the observation period prior to the study, patients in Group 1 with lower volumes of inhaled stomach residues continued to show very low inhaled stomach residue volumes in subsequent studies, with residual inhaled stomachs remaining. For 93% (43/44) of the water volume, the first and second measurements showed values of 75 mL or less. On the other hand, patients in Group 2 (as distinguished by higher gastric residue volume by pre-study observations) continued to show higher inhaled gastric residue volume in subsequent studies, with residual gastric inhalation For only 11% (3/28) of the water volume, both measurements showed values below 75 mL (Table 2). The mean value of the gastric residue volume inhaled was the first measurement (124 ± 7 vs. 14 ± 2 ml, p <0.05), the second measurement, 75 ± 10 vs 15 ± 4 ml, p <0.05), respectively, were significantly higher.

Table 1.GRVs for Group 1 patients (low residual volume) receiving continuous tube feeding First measurement (ml) Second measurement (ml) Patient no. Infusion rate (ml / hr) AspGRV Calgrv Formula remaining AspGRV Calgrv Formula remaining One 75 45 78 39 6 35 33 2 30 40 40 12 15 56 24 3 75 30 55 24 3 79 72 4 75 25 74 17 85 90 14 5 65 20 35 24 4 38 35 6 20 15 75 6 20 60 9 7 45 12 33 32 20 59 35 8 60 10 32 28 5 35 32 9 75 10 34 32 5 37 31 10 50 10 31 23 4 37 28 11 30 10 37 32 35 66 23 12 55 10 37 35 12 35 32 13 30 10 31 26 5 35 29 14 45 8 32 30 3 32 30 15 40 8 34 31 20 97 23 16 30 7 31 29 5 32 30 17 70 7 40 40 11 49 36 18 70 7 36 36 32 69 32 19 70 7 40 40 11 49 36 20 70 6 33 31 5 33 30 21 60 6 33 31 10 33 31 22 30 10 34 31 3 39 34 Mean ± SEM 53 ± 4 14 ± 2 * 41 ± 3 * 29 ± 2 * 15 ± 4 * 50 ± 4 * 31 ± 2 * Legend: GRV = gastric residual volume, Asp GRV = aspirated gastric residual volume, Cal GRV = calculated gastric residual) volume ( p <0.05 for mean value group 1 versus group 2)

Table 2.GRVs for Group 2 patients (high residual volume) receiving continuous tube feeding First measurement (ml) Second measurement (ml) Patient no. Infusion rate (ml / hr) AspGRV Calgrv Formula remaining AspGRV Calgrv Formula remaining One 40 145 104 19 18 39 37 2 70 142 130 51 110 146 62 3 75 140 171 65 110 149 71 4 40 110 200 33 10 37 34 5 40 98 88 18 9 43 39 6 30 128 138 135 97 62 27 7 35 120 116 114 95 50 26 8 30 110 140 141 85 47 22 9 30 160 150 87 80 132 62 10 40 155 110 69 90 115 61 11 30 138 132 75 86 117 51 12 70 130 180 72 100 180 77 13 30 85 193 72 78 119 47 14 30 78 282 110 80 193 72 Mean ± SEM 42 ± 4 124 ± 7 * 152 ± 13 * 76 ± 10 * 75 ± 10 * 102 ± 15 * 49 ± 5 * Legend: GRV = gastric residual volume, Asp GRV = aspirated gastric residual volume, Cal GRV = calculated gastric residual volume ( p <0.05 for mean value group 1 versus group 2)

Tables 3 and 4 show the patterns for the first and second Brix value measurements before and after dilution. In general, patients in group 1 show the opposite pattern, and the pattern in which the pre-dilution brix value decreases more severely than the patients in group 2 (low pre-dilution brix value, which reduces the brix value after higher dilution less). It is shown that the brix value after dilution is much lower due to the declining pattern. In the two measurements between the two groups, only the difference in brix values after dilution has statistical significance.

Table 3. Brix values for Group 1 patients (low residual volume) receiving continuous tube feeding First measurement Second measurement Patient no. Pre-dilutionBrix value Post-dilutionBrix value Brix value ratio Pre-dilutionBrix value Post-dilutionBrix value Brix value ratio One 12.0 7.4 62% 23.0 3.0 13% 2 7.4 1.8 24% 10.4 4.8 46% 3 10.6 4.8 45% 22.0 13.6 62% 4 5.4 3.2 59% 3.6 2.4 67% 5 16.0 2.4 15% 22.6 4.6 20% 6 2.0 1.2 60% 3.6 1.8 50% 7 23.4 2.0 9% 14.2 7.0 49% 8 21.0 1.6 8% 22.2 3.0 14% 9 22.6 2.4 11% 20.2 3.6 18% 10 18.0 0.4 2% 18.0 3.4 19% 11 21.0 4.0 19% 8.4 4.6 55% 12 22.6 4.2 19% 22.0 3.0 14% 13 20.0 0.6 3% 20.0 3.0 15% 14 22.8 1.4 6% 22.6 1.4 6% 15 22.0 2.4 11% 5.8 4.0 69% 16 22.2 1.0 5% 22.6 1.2 5% 17 23.8 6.0 25% 17.6 6.8 39% 18 23.6 4.0 17% 11.0 6.2 56% 19 23.8 6.0 25% 17.6 6.8 39% 20 22.4 2.0 9% 22.0 1.8 8% 21 23.0 2.0 9% 22.2 2.2 10% 22 22.0 2.6 12% 20.8 4.8 23% Mean ± SEM 18.5 ± 1.4 2.9 ± 0.4 * 20 ± 4% * 16.9 ± 1.4 4.2 ± 0.6 * 32 ± 5% * p <0.05 for mean value group 1 versus group 2

Table 4. Brix values for Group 2 patients (high residual volume) receiving continuous tube feeding First measurement Second measurement Patient no. Pre-dilutionBrix value Post-dilutionBrix value Brix value ratio Pre-dilutionBrix value Post-dilutionBrix value Brix value ratio One 4.5 3.2 71% 22.7 5.4 24% 2 9.5 7.3 77% 10.2 8.1 79% 3 9.1 7.5 82% 11.4 9.1 80% 4 4.0 3.4 85% 22.3 4.0 18% 5 5.0 3.3 66% 22.0 6.5 30% 6 23.5 18.4 78% 10.4 5.4 52% 7 23.6 17.5 74% 12.4 5.0 40% 8 24.2 19.0 79% 11.0 4.0 36% 9 14.0 11.2 80% 11.4 8.8 77% 10 15.0 10.9 73% 12.7 9.4 74% 11 13.6 10.5 77% 10.5 7.8 74% 12 9.6 8.0 83% 10.2 8.5 83% 13 9.0 7.6 84% 9.5 7.1 75% 14 9.4 8.4 89% 9.0 7.6 84% Mean ± SEM 12.4 ± 1.9 9.7 ± 1.4 * 79 ± 2% * 13.3 ± 1.3 6.9 ± 0.5 * 59 ± 7% * p <0.05 for mean value group 1 versus group 2

This pattern in group 1 patients showed that the contents of the stomach were found to be significantly higher concentrations (maximum intensity Osmolat HN) in very small volumes (as shown by a significant drop in dilute brix value by a volume of 30 mL distilled water). (As shown by the Brix value before dilution, close to the ex vivo Brix value of 23.2). On the contrary, from the opposite pattern in Group 2 patients, it is more likely by endogenous secretion (as shown by the pre-dilution brix value smaller than the brix value of 23.2 for maximum intensity osmolite HN). Dilution also increases the total volume (as shown by the lowered dilute brix value with a volume of 30 mL distilled water).

The ratio of mean brix values in both groups shows this distinct pattern. Mean Briggs ratios were measured in Group 1 patients for both the first (79 ± 2% vs 20 ± 4%, p <0.05) and second (59 ± 7% vs 32 ± 5%, p <0.05) measurements, respectively. Much higher values were found in patients in group 2 than in. In group 1 patients, the Brix value ratio was found to be less than 70% for all patients (Table 3). For the patients in group 2, the Brix value ratio exceeded 70% for all patients except one (5 patients) for the first measurement (Table 4), but six out of 14 patients for the second measurement. (Patients 1, patients 4 to 8) the Briggs ratio fell below 70%.

In general, patients in group 1 exhibited a prescribed dose measured to remain in very low dimensions, dropping the pattern represented by the Briggs value ratio (Table 1). For any patient whose prescription amount was greater than the hourly intake rate (patient 22), the inhaled gastric residual and estimated gastric residual were less than 40 mL. Eventually, 95% of the patients in Group 1 (21/22) prescribing remained smaller than the real-time intake rate.

In contrast to the patients in group 1, the patients in group 2 showed evidence that the empty space in the stomach was reduced and that the larger space remained the prescription (Table 2). Compared with prescriptions evaluated to remain at the infusion rate in real time, six patients (patients 9 to 14) indicated that the evidence of gastric stasis in all cases coincided with evidence of decreased gastric emptying. there was. For these six patients, the prescribed dose was greater than the real-time infusion rate for all cases. In the above six, the ratio of the values of the first and second bric was more than 70%. However, gastric residue inhalation has traditionally decreased and failed to identify these patients, with less than 100 mL for the first of two of six and the second of six. Three patients in group 2 (patients 6-8) who showed congestion at the first measurement show that the following measurements accurately represent the above fasting state. The five patients may be the same in that the prescription amount has a higher inhalation residual from Group 2 where the prescribed dose was less than the real-time infusion rate and the stomach was evaluated to be empty longer.

These findings demonstrate how refractometric measurements have been used in relation to residual gastric inhalation to establish measures to monitor patients with continued gastric intake. Determination of the volume of inhaled gastric inhalation performed every four hours, a conventional method, was considered to be the most important for the initial montering. As can be seen in the above study, patients with residual gastric inhalation of 75 mL or less (including clinical suspicion of tolerance, increased abdominal swelling, decreased gas and stool passage, vomiting, etc.). If not intensified) (FIG. 4) it appears to be less dangerous, has excellent resistance and sufficient gastric emptying force, and does not require refractometric evaluation. If patients are found to have residual gastric inhalation in excess of 75 mL in two or more cases, a simple Briggs value dilution test should be performed. As can be seen in this study, if the Brix value ratio is less than 70%, the probability of stagnation is low and food will continue. However, in two or more cases (performed every four hours) if the Briggs value ratio exceeds 70%, the clinician should analyze the amount of prescription remaining in the stomach. The discovery that the diet is greater than the real-time infusion rate will inform clinicians the possibility of delaying emptying of the stomach with regard to congestion. And feeding should be continued with caution under close observation (continue to carry out Brix value dilution test with residual gastric inhalation every 4 hours).

The Brix value is a measure of the total soluble material, which is measured by a refractometer which has a constant value for pure material in solution under conditions of constant temperature and constant pressure. The brix value is a value closely related to the mole fraction of the component. In other words, all brix values in the mixed solution are generally close to the sum of brix values of the individual components. Refractive index measurement method for estimating the amount of food is a prospect that can be measured relatively accurately with a minimum number of variables. Furthermore, the Brix value measurement is fast, simple, repeatable, inexpensive and has a moderate effect on the standardization of the measurement, in addition to being able to monitor the contents of the food.

Claims (12)

In the method for measuring the concentration of dietary formula in the above contents, Iii) injecting a dietary formula into the stomach of the patient, Ii) obtaining the above contents over an appropriate time after injection, measuring the brix value of the contents, and Iii) Percent concentration of dietary formula = Brix value / slope value, the slope value is a brix of the concentration of the dietary formula after diluting the dietary formula in order to obtain the concentration of the dietary formula Measuring the value, obtained by using the resultant concentration and brix value to obtain the slope value from the regression method, and using the equation to obtain the percent concentration of the dietary formula in the above contents. Method of measuring parameters in the stomach. The method of claim 1, Said inclination value is 0.24, The measuring method of the parameter in the stomach, It is characterized by the above-mentioned. The method of claim 1, The dietary formula is a method for measuring the gastrointestinal parameters, characterized in that the formula for supply through the nasal nutrient tube. The method of claim 1, The dietary formula is a liquid dietary formula, characterized in that the method of measuring the parameters in the stomach. In the method for measuring the residue volume in the stomach, Iii) determining the brix value of the above residue volume to obtain BV1, Ii) adding an appropriate amount of water to the gastric residue volume to produce a mixed gastric contents, Iii) injecting the mixed stomach contents into the stomach; Iii) inhaling the contents of the stomach mixed from the stomach, Iii) determining a brix value to obtain BV2 from the resulting contents above, and Iii) obtaining the volume of gastric contents through the equation (BV1 × amount of water added) / (BV1-BV2). The method of claim 5, wherein The Brix value is measured by a refractometer. In the method for measuring the volume of dietary formula in the stomach, Wherein said volume is multiplied by the gastric residue volume calculated according to the present invention to the maximum strength% value of the dietary formula. The method of claim 7, wherein The dietary formula is a method for measuring the gastrointestinal parameters, characterized in that the supply through the nasal tube. The method of claim 7, wherein The dietary formula is a liquid dietary formula, characterized in that the method of measuring the parameters in the stomach. In the method of measuring the volume of gastric juice in the stomach, The above method is a method of measuring gastrointestinal parameters by subtracting the volume of dietary formula remaining in the stomach from the volume of gastric residues. The method of claim 10, The dietary formula is a method for measuring parameters in the stomach, characterized in that the formula is supplied through the nasal nutrient tube. The method of claim 10, The dietary formula is a liquid dietary formula, characterized in that the method of measuring the parameters in the stomach.