分析急性呼吸窘迫综合征（ARDS）患者俯卧位通气（PPV）期间肠内营养（EN）的耐受情况。

收集2013年2月至2017年10月期间广州医科大学附属第一医院重症医学科60例ARDS患者的临床资料。根据患者每次PPV前后分为PPV前组及PPV组；经喂养方式分为胃管组及幽门后组；胃管组PPV期间EN速度相比每次PPV前的营养速度分为减速组及非减速组；PPV时间≥12 h为高强度PPV，根据PPV时间分为≥12 h组和≥16 h组。回顾分析各组患者行PPV治疗期间EN的情况。

60例ARDS患者共行321次PPV治疗，胃管组有274次，幽门后组有47次。非减速组为122次，PPV时间≥12 h有89次（72.95%），PPV时间≥16 h有65次（53.28%）；减速组152次，PPV时间≥12 h有77次（50.66%），PPV时间≥16 h有63次（41.45%）。胃管组在PPV治疗期间的胃残留量（GRV）、呕吐、口鼻腔可见食物残渣率和PPV前比较差异均无统计学意义（P>0.05），即使减慢PPV期间EN速度、应用高强度PPV所得结果相近；胃管组和幽门后组的呕吐、口鼻腔可见食物差异无统计学意义（P>0.05），但热卡摄入量低于幽门后组。

ARDS患者行PPV并不增加胃潴留及EN反流的风险。PPV期间不需特别减慢EN速度；对于有胃潴留或EN不达标的ARDS患者需要行PPV治疗，幽门后置管喂养是选择。

To analyze the tolerance of enteral feeding of ARDS patients receiving prone position.

A total of 60 patients in Intensive Care Unit of the First Affiliated Hospital of Guangzhou Medical University receiving invasive mechanical ventilation in the prone position with enteral feeding were studied during February 2013 to October 2017. They were divided into the pre-PPV group and the PPV group before and after each PPV peroid of each patient; they were divided into nasogastric and post-pylorus group by the feeding canal; the nasogastric group was divided into deceleration and non-deceleration group by enteral nutrition speed before PPV; high-strength group was the group that PPV time was more than 12 h, according to the time there were ≥ 12 h and ≥ 16 h group.

60 ARDS patients underwent 321 peroids of PPV, 274 peroids were feeded by nasogastric tube, another 47 were trans-pylorus feeded; When the time of PPV was more than 12 hours, 89 (72.95%) peroids were in the non-deceleration group, another group had 77 peroids (50.66%). When the time of PPV was more than 16 hours, they were 65 (53.28%) and 63(41.45%) peroids. There were no significant differences in GRV, vomiting or diet regurgitation between pre-PPV and PPV group (P>0.05), whether or not to slow the rate of enteral nutrition by nasogastric tube.The same results were found when the prone time is no less than 12 h. There were no significant differences in vomiting or diet regurgitation in gastric and post-pyloric canal, but calorie intake by post-pyloric canal was higher.

EN in critically ill patients with ARDS receiving mechanical ventilation in PP is feasible, safe, and not associated with an increased risk of gastric retention and EN reflux. Do not slow down the rate of enteral nutrition during PPV. For patients with gastric retention or non - standard enteral nutrition, transpylorus feeding may be the choice.