ICU危重患者肠内营养并发症的危险因素分析

发布时间：2019-03-03 16:50

【摘要】：目的危重患者常常处于营养不良且高代谢的应激状态,早期肠内营养对改善营养供应、维持胃肠道正常的消化吸收和免疫功能、缩短平均住院时间、降低死亡率具有重要作用,但肠内营养并发症的发生影响了肠内营养的治疗效果。本研究的目的在于调查重症监护病房(ICU)危重患者三种常见肠内营养并发症:腹泻、便秘、反流的发生现状,初步探究其相关危险因素,为采取相应的预防性干预措施和优化改进肠内营养治疗方案提供依据。方法通过文献研究的方法并与相关临床工作人员进行讨论确定了可能引起肠内营养并发症的相关危险因素:年龄、性别、鼻饲速度、日鼻饲量、鼻饲液种类、是否患糖尿病、是否应用抗生素、是否肾功能不全、是否禁食、是否应用镇痛剂、是否口服钾制剂、是否机械通气。调查分析了青岛市3家三甲医院4所ICU 2015年9月至2016年10月的759例肠内营养患者的相关资料,使用SPSS19.0统计软件统计并分析肠内营养并发症的发生情况及危险因素,利用X~2检验对可疑危险因素进行单因素分析,初步确定肠内营养并发症的危险因素,然后将所有的可疑危险因素引入多因素二项logistic回归分析,筛选出肠内营养并发症的危险因素。结果267名患者发生腹泻,发生率为35.17%;212名患者发生便秘,发生率27.93%;226名患者发生反流,发生率为29.77%。腹泻与未腹泻患者在应用抗生素、年龄、禁食、口服钾制剂,鼻饲速度、日鼻饲量等方面具有统计学差异;便秘与未便秘患者在鼻饲液种类、应用镇痛剂、年龄、鼻饲速度、日鼻饲量等方面具有统计学差异;反流与未反流患者在应用镇痛剂、机械通气、年龄、鼻饲速度、日鼻饲量等方面有统计学差异。结论应用抗生素、年龄增加、禁食、口服钾制剂、鼻饲速度加快、日鼻饲量增加是肠内营养患者腹泻发生的危险因素;短肽或单体型肠内营养液、应用镇痛剂、年龄增加是肠内营养患者便秘的危险因素;机械通气、年龄增加、鼻饲速度加快、鼻饲量增加是肠内营养患者反流的危险因素。
[Abstract]:Objective severe patients are often in the stress state of malnutrition and high metabolism. Early enteral nutrition plays an important role in improving nutrition supply, maintaining normal digestive absorption and immune function of gastrointestinal tract, shortening average hospitalization time and reducing mortality. However, the complications of enteral nutrition affect the therapeutic effect of enteral nutrition. The purpose of this study was to investigate the current situation of three common enteral nutrition complications: diarrhea, constipation and reflux in critical patients with (ICU) in intensive care unit (ICU), and to explore the related risk factors. To provide the basis for taking corresponding preventive intervention measures and optimizing the improvement of enteral nutrition treatment program. Methods the related risk factors including age, sex, speed of nasal feeding, amount of nasal feeding, type of nasal feeding fluid and diabetes mellitus were identified by literature study and discussed with relevant clinical staff, and the related risk factors were age, sex, nasal feeding speed, nasal feeding volume, type of nasal feeding fluid, diabetes mellitus (DM) and diabetes mellitus (DM). Whether to use antibiotics, whether renal dysfunction, whether fasting, whether to use painkillers, whether oral potassium preparation, whether mechanical ventilation. The data of 759 patients with enteral nutrition in 4 ICU hospitals from September 2015 to October 2016 in Qingdao City were investigated and analyzed. The incidence and risk factors of complications in enteral nutrition were analyzed by using SPSS19.0 statistical software. The risk factors of complications of enteral nutrition were preliminarily determined by univariate analysis of suspicious risk factors by X-ray test, and then all the suspicious risk factors were introduced into multi-factor binomial logistic regression analysis. Risk factors for complications of enteral nutrition were screened. Results 267 patients suffered from diarrhea, the incidence of constipation was 35.17% (212 / 212), the incidence of reflux was 27.93% (226 / 226), the incidence was 29.77%. There were statistical differences in the use of antibiotics, age, fasting, oral potassium preparation, nasal feeding speed and daily nasal feeding quantity between diarrhea and non-diarrhoea patients. There were statistical differences between patients with constipation and those without constipation in the types of nasal feeding fluid, the use of painkillers, age, nasal feeding speed, daily nasal feeding volume, and so on. There were statistical differences in the use of analgesic, mechanical ventilation, age, nasal feeding speed and daily nasal feeding volume between patients with reflux and non-regurgitation. Conclusion the use of antibiotics, age, fasting, oral potassium preparation, the speed of nasal feeding is faster, and the increase of daily nasal feeding is the risk factor of diarrhea in patients with enteral nutrition. Short peptide or haplotype enteral nutrition solution, the use of analgesic, age is the risk factor of constipation in patients with enteral nutrition, mechanical ventilation, age increase, nasal feeding speed up, increase in nasal feeding is the risk factors of reflux in patients with enteral nutrition.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473

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