ICU长期机械通气患者发生便秘的相关因素分析：一项前瞻性观察性队列研究  

Correlation factor analysis on constipation in long-term ventilated patients in intensive care unit： a prospective observational cohort study

作　　者：代明营[1] 王慧敏[1] 李堃[1] 于帮旭[1] 潘新亭[1] 

机构地区：[1]青岛大学附属医院重症医学科,山东青岛266003

出　　处：《中华危重病急救医学》2017年第1期75-80,共6页Chinese Critical Care Medicine

基　　金：中国博士后科学基金资助项目（2015M582058）

摘　　要：目的探讨重症加强治疗病房（ICU）长期机械通气患者发生便秘的相关因素及其对预后的影响。方法采用前瞻性观察性队列研究方法，选择2013年10月1日至2015年9月30日青岛大学附属医院综合ICU收治的机械通气（MV）时间≥6d的患者，按入住ICU后排便时间分为早期排便组（〈6d）和延迟排便组（≥6d）C数据收集期间，患者的营养支持方案按常规进行，记录患者的性别、年龄、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、病例来源、MV原因、应用乳果糖和吗啡类药物以及肾上腺素／去甲肾上腺素情况、最高呼气末正压（PEEP）、最低氧合指数（PaO2／FiO2）、最低收缩压等；采用多元回归方法分析影响首次排便时间的相关因素。观察早期排便组和延迟排便组患者ICU病死率、ICU住院时间、MV时间、中心静脉导管（CVC）留置时间、ICU获得性细菌感染和呼吸机相关性肺炎（VAP）发生率及MV不同时间点Logistic器官功能障碍评分（LOD）和每日胃残留量。结果入选189例患者，排除39例不符合纳入标准和13例中途放弃治疗或转院患者，最终共137例患者纳入分析，其中延迟排便组83例，早期排便组54例。两组患者性别、年龄、APACHEⅡ评分、病例来源、MV1dLOD评分、MV原因、MV5d内发生呕吐和每日胃残留量、营养支持、MV5d内肝性脑病患者乳果糖治疗及血液净化治疗等差异均无统计学意义（均P〉0．05）。与早期排便组比较，延迟排便组首次排便为稀便或水样便比例更低（15．7％（13／83）比33．3％（18／54）]，应用吗啡类药物和应用肾上腺素／去甲肾上腺素〉24h比例更高[48．2％（40／83）比40．7％（22／54），42．2％（35／83）比29．6％（16／54）]，呼吸机最高PEEP水平更高[cmH2O（1cmH2O=0．098kPa）：7．9±3．7比6．7±3．5]，最低收缩压更低[mmHg（1mmHg=0．133kPa）：74．8�Objective To explore the factors associated with delayed defecation in long-term ventilated patients in intensive care unit （ICU） and their potential effect on prognosis. Methods A prospective observational cohort study was conducted. The patients admitted to general ICU of the Affiliated Hospital of Qingdao University from October 1st in 2013 to September 30th in 2015 who underwent mechanical ventilation （MV） for ≥ 6 days were enrolled, and they were divided into early defecation group （〈 6 days） and late defecation group （ ≥ 6 days）. At admission, clinical nutritional support were given as usual, and gender, age, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score, admission reasons, MV reasons, the usage of morphine and epinephrine/norepinephrine, the highest positive end-expiratory pressure （PEEP）, the lowest oxygenation index （PaO2/FiO2） and the lowest systolic blood pressure were collected. Logistic regression analysis was used to analyze the influencing factors of the first defecation time. ICU mortality, the length of ICU stay, central venous catheter （CVC） indwelling time, duration of MV, ICU acquired bacterial infection rate, and the incidence of ventilator associated pneumonia （VAP） were compared between early defecation group and late defecation group. Logistic organ dysfunction system （LOD） scores and gastric residual volume per day were recorded at the different time of MV. Results Totally 189 patients were enrolled, 39 patients did not satisfied the inclusion criteria and 13 patients gave up treatment or referrals were excluded. Finally 137 patients were enrolled in the analysis, 83 patients in late defecation group and 54 in early defecation group. There were no significant differences in the baseline characteristics such as gender, age, APACHE Ⅱ score, LOD score at 1 day of MV, admission reasons, MV reasons, disgorging and gastric residual volume per day during the first 5 days of MV, enteral nutrition, lactulose treatment in pati

关 键 词：便秘 重症加强治疗病房 机械通气 预后 

分 类 号：R459.7[医药卫生—急诊医学]