[1]徐 瑶,叶向红,李嘉琪,等.腹部创伤病人肠内营养喂养不耐受的影响因素分析及对预后影响的研究[J].肠外与肠内营养杂志,2023,(06):351-356.[doi:10.16151/j.1007-810x.2023.06.006]
　XU Yao,YE Xiang-hong,LI Jia-qi,et al.Analysis of risk factors for enteral nutrition feeding intolerance in patients with abdominal trauma patients and its impact on clinical outcomes[J].PARENTERAL & ENTERAL NUTRITION,2023,(06):351-356.[doi:10.16151/j.1007-810x.2023.06.006]
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腹部创伤病人肠内营养喂养不耐受的影响因素分析及对预后影响的研究()
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2023年06期
页码:
351-356
栏目:
论著
出版日期:
2023-12-10

文章信息/Info

Title:
Analysis of risk factors for enteral nutrition feeding intolerance in patients with abdominal trauma patients and its impact on clinical outcomes
作者:
徐 瑶 1; 叶向红2; 李嘉琪 3; 左俊焘3; 谢文慧 1
1.蚌埠医学院研究生院，安徽蚌埠 233000；2.东部战区总医院全军普通外科研究所，江苏南京 210002；3.南京大学医学院，江苏南京 210093
Author(s):
XU Yao1;  YE Xiang-hong2;  LI Jia-qi3;  ZUO Jun-tao3;  XIE Wen-hui1
1.Graduate School, Bengbu Medical College,Bengbu 233000, Anhui,China；2.Department of General Surgery, General Hospital of Eastern Theater Command, PLA, Nanjing 210093, Jiangsu, China；3.Medical College of Nanjing University, Nanjing 210093, Jiangsu, China
关键词:
腹部创伤 ; 喂养不耐受 ; 影响因素 ; 预后
Keywords:
Abdominal trauma;  Feeding intolerance;  Risk factor;  Clinical outcomes
分类号:
R473，R459.3
DOI:
10.16151/j.1007-810x.2023.06.006
文献标志码:
A
摘要:
目的：探讨腹部创伤病人肠内营养喂养不耐受的影响因素以及对其预后的影响。 方法：采用便利抽样法，对2021年12月至2022年12月就诊于东部战区总医院普通外科的117例行肠内营养治疗的腹部创伤病人的病历资料进行回顾，将病人分为肠内营养喂养耐受组与肠内营养喂养不耐受组，将单因素分析结果中P < 0.05的指标纳入Logistic回归分析，得出腹部创伤病人喂养不耐受的独立危险因素，并分析喂养不耐受对腹部创伤病人预后的影响。 结果：肠内营养喂养耐受组75例，肠内营养喂养不耐受组42例。单因素分析结果显示两组病人在腹腔开放、损伤严重程度评分（ISS）、肠内营养开始时间、儿茶酚胺类药物之间的差异有统计学意义（P < 0.05）；Logistic回归分析结果显示腹腔开放（OR = 6.598，95%CI：1.349 ~ 32.256，P < 0.05）、ISS（OR = 5.555，95%CI：1.978~ 15.599，P < 0.05）、肠内营养开始时间（OR = 3.566，95%CI：1.174 ~ 10.835，P < 0.05）是引起腹部创伤病人发生喂养不耐受的危险因素。两组病人肠内营养达标天数、ICU住院时间、总住院时间、住院费用、感染性并发症、3个月再入院率比较差异有统计学意义（P < 0.05）。 结论：ISS评分越高、开始肠内营养时间越迟、行腹腔开放治疗会增加喂养不耐受的发生风险，以及肠内营养喂养不耐受对预后有不利影响。
Abstract:
Objective: To explore the risk factors for enteral feeding intolerance (FI) in patients with abdominal trauma and its impact on clinical outcomes. Methods: The medical records of 117 patients with abdominal trauma treated with enteral nutrition in a tertiary hospital from December 2021 to December 2022 were retrospectively reviewed by convenience sampling method. The patients were divided into tolerance group and intolerance group. The indicators with P < 0.05 in the results of univariate analysis were included in logistic regression analysis to obtain the independent risk factors of enteral nutrition FI in patients with abdominal trauma, and to analyze the effect of enteral nutrition intolerance on the clinical outcomes. Results: There were 75 patients in tolerance group and 42 patients in intolerance group. Univariate analysis showed that there were significant differences in the presence of open abdomen, injury severity scores (ISS) score, initiation time of enteral nutrition and receipt of catecholamine drugs between the two groups (P < 0.05). Logistic regression analysis showed that the presence of open abdomen (OR = 6.598, 95%CI 1.349 ~ 32.256,P< 0.05), ISS score (OR = 5.555,95%CI：1.978 ~ 15.599,P < 0.05), initiation time of enteral nutrition (OR = 3.566,95%CI：1.174 ~ 10.835,P < 0.05) were risk factors for FI in patients with abdominal trauma. There were statistically significant differences in the days of full feeding, length of ICU stay, length of hospital stay, hospitalization expenses, incidence of infectious complications, and readmission rate within 3 months between the two groups (P< 0.05). Conclusion: Thehigher ISS score, delayed enteral nutrition, and presence of open abdomen may increase the risk of FI, and FI has adverse effects on clinical outcomes.

参考文献/References:


[1] 张 波,桂 莉 . 急危重症护理学 . 北京:人民卫生出版,2017:101-107.
[2] 王玉东 . 严重腹部创伤急诊重症监护病房加强治疗的价值评价.实用医技杂志, 2019,26(5):615-617.
[3] 王万鹏,刘燕燕,崔宗朝,等.闭合性腹部损伤患者死亡危险因素分析.中国实用内科杂志, 2021,41(3):234-237.
[4] 刘 峰.严重腹部创伤患者损伤控制复苏护理方案的构建.安徽:蚌埠医学院,2020.
[5] Dijkink S, Meier K, Krijnen P, et al. Malnutrition and its effects in severely injured trauma patients. Eur J Trauma Emerg Surg,2020,46(5):993-1004.
[6] Gungabissoon U, Hacquoil K, Bains C, et al. Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness. JPEN J Parenter Enteral Nutr,2015,39(4):441-448.
[7] Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr, 2019,38(1):48-79.
[8] Moore SM, Burlew CC.Nutrition Support in the Open Adbomen. Nutr Clin Pract,2016,31(1):9-13.
[9] Ke L, Lin J, Doig GS, et al. Actively implementing an evidence based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial. Crit Care, 2022,26(1):46.
[10] 叶向红,宫雪梅,王慧君,等. 早期肠内营养耐受性分级干预在重症病人中的应用 . 肠外与肠内营养, 2020, 27 (2): 89-93.
[11] 亚洲急危重症协会中国腹腔重症协作组. 重症病人胃肠功能障碍肠内营养专家共识（2021 版）. 中华消化外科杂志, 2021,20(11): 1123-1136.
[12] Reintam BA, Malbrain ML, Starkopf J, et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med, 2012, 38(3): 384-394.
[13] Coccolini F, Montori G, Ceresoli M, et al. IROA: International Register of Open Abdomen, preliminary results. World J Emerg Surg, 2017,12:10.
[14] Wang Z, Wu L, Fang Q, et al. Effects of capsaicin on swallowing function in stroke patients with dysphagia: A randomized controlled trial. J Stroke Cerebrovasc Dis, 2019,28(6):1744-1751.
[15] Yandell R, Wang S, Bautz P, et al. A retrospective evaluation of nutrition support in relation to clinical outcomes in critically ill patients with an open abdomen. Aust Crit Care, 2019, 32(3):237-242.
[16] 杨 昆,毕庆思.老年脓毒症休克患者腹内压对容量反应性的影响.中国老年学杂志, 2021,41(9):1875-1878.
[17] 王新颖,李维勤,赵允召,等.腹腔开放患者的肠内营养支持.中华外科杂志,2007,45(13):891-893.
[18] 刘云访, 李素云, 喻姣花, 等. 肠内营养并发腹泻、腹胀风险预警分级标准及干预方案的构建 . 护理研究, 2022,36(20):3701-3705.
[19] 王 婷, 许 磊, 杨文群, 等.创伤后肠内营养喂养不耐受的影响因素分析. 重庆医科大学学报, 2016,41(3):274-277.
[20] 中华医学会消化病学分会胃肠激素与黏膜屏障学组.胃肠道黏膜保护临床专家共识(2021年，福州). 中华消化杂志，2021，41(12):798-811.
[21] 江 舟,游宠捷,戴文斌.闭合性腹部创伤中肠道损伤的诊断与治疗.中国医药指南,2021,19(32):18-20.
[22] 曾宪国,陈黎新,陈自力,等.早期肠内营养对严重腹部创伤术后患者营养状态、免疫功能和肠屏障功能的影响. 中国医学创新,2018,15(16):24-27.
[23] Coccolini F, Roberts D, Ansaloni L, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg, 2018,13:7.
[24] Song J, Zhong Y, Lu X, et al. Enteral nutrition provided within 48 hours after admission in severe acute pancreatitis: A systematic review and meta-analysis. Medicine (Baltimore), 2018, 97(34):e11871.
[25] 孙仁华,江荣林,黄 曼,等.重症患者早期肠内营养临床实践专家共识.中华危重病急救医学,2018(8):715-721.
[26] Merchan C, Altshuler D, Aberle C, et al. Tolerability of Enteral Nutrition in Mechanically Ventilated Patients With Septic Shock Who Require Vasopressors. J Intensive Care Med, 2017, 32(9):540-546.
[27] Berger MM, Bollmann MD, Revelly JP, et al. Progression rate of self-propelled feeding tubes in critically ill patients. Intensive Care Med,2002,28(12):1768-1774.
[28] Li PF, Wang YL, Fang YL, et al. Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care. Chin J Traumatol, 2020,23(3):163-167.
[29] 肖 洪, 张连阳, 王耀丽, 等. 肠内营养在腹腔感染渐进性关腹患者中的应用. 创伤外科杂志, 2022,24(10):777-781.
[30] 叶向红,顾璐璐,黄娴雅,等.腹部创伤病人行无创氧疗期间肠内营养并发症发生的危险因素分析 . 肠外与肠内营养, 2022,29(5):285-291.

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备注/Memo

备注/Memo:
作者简介 ：徐 瑶，硕士研究生，从事临床营养研究。E-mail:20211054006@stu.bbmc.edu.cn通讯作者 ：叶向红，E-mail:icuyz@126.com
更新日期/Last Update: 1900-01-01