危重症患者胃肠功能障碍发生危险因素的前瞻性研究  

Prospective study on the risk factors of gastrointestinal dysfunction in critically ill patients

作　　者：刘海燕[1] 李维勤[2] 

机构地区：[1]安徽医科大学第一附属医院重症医学科,安徽省合肥230022 [2]南京军区总医院普外科

出　　处：《中国基层医药》2013年第23期3521-3523,I0001,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：基金项目：解放军十一五自然科学基金项目（06C,041）;安徽省高校省级自然科学研究项目（KJ20122174）;安徽医科大学第一附属医院培育基金（2011KJ18）

摘　　要：目的通过胃肠功能评分来评价危重症患者胃肠功能障碍，并研究原发疾病及腹腔感染与危重症患者胃肠功能障碍发生的相关性。方法对收治入外科ICU的≥18岁成年人危重症患者胃肠道功能进行前瞻性观察研究。患者入科后即进行性别、年龄、原发病等信息采集，根据原发病分为两组：非腹部外科疾病组（A组）和腹部外科疾病组（B组）。两组患者均进行腹部体征的连续观察，人科24h内记录影响胃肠道功能的危险因素，记录APACHEII评分，ICU治疗时间和住院时间。结果B组胃肠功能评分比A组高[（6．8±3．8）分与（2．6±2．6）分，t=9．1，P〈0．01]；腹部外科疾病是发生胃肠功能障碍的独立危险因素（95％CI：1．999—15．509，P〈0．01）。在B组中，合并腹腔感染患者胃肠功能评分显著高于其他患者[（9．6±3．0）分与（5．4±5．4）分，t=6．5，P〈0．01]，ICU滞留率也明显升高（70．6％与8．1％，x。=45．6，P〈0．01）。腹腔感染是导致严重胃肠功能障碍的独立危险因素（95％CI：2．259—1336．797，P=0．014）。两组之间ICU病死率差异无统计学意义（P〉0．05）。结论原发性腹部外科疾病是胃肠功能障碍的诱发因素。Objective To explore the roles of original disease and abdominal cavity infection in gastrointesti- nal（GI） dysfunction and try to design a＇gastrointestinal function score＇to evaluate the severity of GI dysfunction in critically iU patients. Methods The GI function of consecutive critically ill patients ≥18 years old admitted to surgi- cal intensive care unit （ICU） were prospectively studied. The patients were divided into two groups according to pri- mary diseases：non-abdominal surgical disease group（group A） and abdominal surgical disease group （group B）. An initial history was taken and physical examination performed after admission to ICU. The Acute Physiology and Chronic Health Evaluation（APACHE）II score was determined within 24h after admission. Demographic information including age and sex was analyzed for each patient. ICU outcome and ICU length of stay （LOS） were recorded. Results Pa- tients in group B got higher GI function score than group A [ （6.8 ± 3.8 ） vs （2.6 ± 2.6 ）, t = 9.1, P 〈 0.01 ]. The primary disease of abdominal surgical problem was an independent risk factor of GI dysfunction（95% CI： 1. 999- 15. 509,P 〈 0.01 ）. Patients who got abdominal cavity infection had significantly higher GI function score [ （9.6 ±3.0） vs （5.4 ± 5.4）, t = 6.5, P 〈 0. O1 ] and longer LOS percentage than patients without abdominal cavity infection （70.6% vs 8.1% ,x2 =45.6 ,P 〈0.01 ）. Abdominal cavity infection was an independent risk factor of severe GI dys- function（95% C1：2. 259-1336. 797 ,P = 0.014）. The difference of ICU mortality between the two groups was not sig- nificant （P 〉 0.05）. Conclusion Primary surgical abdominal disease was a predisposing factor of GI dysfunction.

关 键 词：危重症 胃肠功能障碍 腹腔感染 

分 类 号：R459.7[医药卫生—急诊医学]