脓毒症患者肠内营养喂养不耐受现况及影响因素研究

doi:10.12183/j.scjpm.2023.0174

摘要/Abstract

摘要： 目的分析脓毒症患者肠内营养喂养不耐受现况及影响因素,为制订有效的干预措施提供借鉴资料。方法以2019年1月至2021年12月山东第一医科大学第一附属医院进行肠内营养的脓毒症患者为研究对象,由医护人员对患者在肠内营养过程中进行是否发生喂养不耐受情况监测,并收集患者基本信息、疾病情况及药物使用情况等,采用描述性分析方法对肠内营养喂养不耐受发生情况进行分析,并采用单、多因素分析方法对脓毒症患者肠内营养喂养不耐受的影响因素进行分析。结果共获得526例研究对象,肠内营养喂养不耐受218例,发生率为41.44%,多发生于肠内营养3~4 d内,占44.50%,不耐受持续时间多为1 d,占46.33%,主要表现为腹泻（62.39%）、腹胀（40.83%）、大量胃潴留（15.60%）等。多因素Logistic回归分析结果显示血糖（OR=2.021）、血清白蛋白（OR=0.209）、使用镇静/止痛剂（OR=1.335）、使用抑酸剂（OR=1.530）、使用钾制剂（OR=1.677）、服用益生菌（OR=0.640）、抗生素使用种类（OR=1.471）、机械通气（OR=3.009）是脓毒症患者肠内营养喂养不耐受的影响因素。结论脓毒症患者肠内营养喂养不耐受发生率高,且影响因素复杂多样,应加强对使用镇静/止痛剂、抑酸剂、钾制剂、益生菌、抗生素及机械通气因素的重视,监测血糖、血清白蛋白,针对个体情况选择适合的肠内营养置管方式、营养制剂,并在肠内营养期间加强巡视和观察,预防和减少喂养不耐受发生。

关键词: 脓毒症, 肠内营养, 喂养不耐受, 影响因素

Abstract: Objective To analyze the status and influencing factors of enteral nutrition feeding intolerance in patients with sepsis, and to provide a reference for effective intervention measures. Methods Patients with sepsis who received enteral nutrition at the First Affiliated Hospital of Shandong First Medical University from January 2019 to December 2021 were selected as subjects. Medical staff monitored whether patients experienced feeding intolerance during enteral nutrition, and collected patients' basic information, disease status, and drug use. The descriptive analysis method was used to analyze the occurrence of enteral nutrition feeding intolerance, and univariate and multivariate analysis methods were used to analyze the influencing factors of enteral nutrition feeding intolerance in patients with sepsis. Results A total of 526 subjects were obtained, and with 218 cases of enteral nutrition feeding intolerance, the incidence rate was 41.44%. Most intolerances occurred within 3-4 days of enteral nutrition, accounting for 44.50%, and the duration of intolerance was mostly 1 day, accounting for 46.33%. The main manifestations were diarrhea （62.39%）, abdominal distension （40.83%）, and gastric retention （15.60%）. Multivariate Logistic regression analysis showed that blood glucose （OR=2.021）, serum albumin （OR=0.209）, use of sedatives/analgesics （OR=1.335）, use of acid suppressor （OR=1.530）, use of potassium preparations （OR=1.677）, use of probiotics （OR=0.640）, type of antibiotic use （OR=1.471）, and mechanical ventilation （OR=3.009） were the influencing factors of enteral nutrition feeding intolerance in patients with sepsis. Conclusions The incidence of enteral nutrition feeding intolerance in patients with sepsis is high, and the influencing factors are complex and diverse. Attention should be paid to the use of sedatives/analgesics, acid suppressor, potassium preparations, probiotics, antibiotics, and mechanical ventilation. Blood glucose and serum albumin should be monitored. Appropriate enteral nutrition catheterization and nutritional preparations should be selected according to individual conditions, and inspection and observation should be strengthened during enteral nutrition to prevent and reduce feeding intolerance.

Key words: Sepsis, Enteral nutrition, Feeding intolerance, Influencing factor

中图分类号:

R153.9

张丽华, 张莉, 张丽萍, 吴艳, 奚玫. 脓毒症患者肠内营养喂养不耐受现况及影响因素研究[J]. 华南预防医学, 2023, 49(2): 174-178.

ZHANG Li-hua, ZHANG Li, ZHANG Li-ping, WU Yan, XI Mei. Enteral nutrition feeding intolerance and its influencing factors in patients with sepsis[J]. South China Journal of Preventive Medicine, 2023, 49(2): 174-178.

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