重症患者肠内营养喂养不耐受临床常用措施效果分析  

Efficacy of medical and nursing measures for enteral nutrition intolerance in critically ill patients

作　　者：许磊[1] 王婷[1] 陈亭[1] 梁泽平[2] 姚娟[2] 朱京慈[1] 

机构地区：[1]第三军医大学护理学院基础护理教研室,重庆400038 [2]第三军医大学大坪医院野战外科研究所重症医学科,重庆400042

出　　处：《第三军医大学学报》2017年第11期1171-1176,共6页Journal of Third Military Medical University

摘　　要：目的观察分析临床常用医疗护理措施对减少重症患者肠内营养喂养不耐受发生的效果。方法观察并记录2016年3-10月入住大坪医院ICU并实施肠内营养的160例重症患者的相关资料,对最终符合标准的109例患者,在肠内营养开始时按照患者选择的营养液类型,是否早期(肠内营养开始时)采取导泻、灌肠、使用促胃动力药物,是否补充白蛋白、使用益生菌、添加谷氨酰胺、联合给予肠外营养进行二分类分组。先采用单因素分析,再将单因素分析结果中P<0.1的指标纳入多因素Logistic回归模型进行分析。结果单因素分析显示:营养液类型、早期导泻、早期灌肠、早期使用促胃动力药物、补充白蛋白对减少喂养不耐发生的效果差异具有统计学意义(P<0.05);多因素分析显示:选择整蛋白型营养液(OR=0.152,P=0.001,95%CI:0.052~0.446),早期使用促胃动力药(OR=0.197,P=0.015,95%CI:0.054~0.726),早期灌肠(OR=0.251,P=0.010,95%CI:0.088~0.718)是降低喂养不耐受发生率的独立保护因素。结论在重症患者肠内营养一开始,选用整蛋白型营养液(胰腺炎患者除外),采取早期使用促胃动力药物、早期灌肠能有效减少喂养不耐受的发生。Objective To observe and analyze the effect of clinical common medical and nursing measures on enteral nutrition intolerance in critically ill patients. Methods Clinical data of 160 critically ill patients hospitalized in ICU of Daping Hospital from March to October 2016 were collected and analyzed. Eventually 109 patients meeting our inclusion criteria were included. The patients divided into 2 groups according to the types of nutrient solution, whether they early used catharsis, enema and prokinetic drugs （ at the beginning of enteral feeding）, and whether supplement of albumin, probiotics, mixed glutamine innutrient solution, and in combination of parenteral nutrition. Univariate analysis was used, and those with P 〈 0.1 in the univariate analysis were evaluated by multivariate logistic regression analysis. Results Univariate analysis showed that type of nutrient solution, early use of catharsis, early use of enema, early use of prokinetic drugs, and supplement of album reduced the effect of enteral nutrition intolerance significantly （P 〈 0.05 ）. Multivariate logistic regression analysis indicated that type of nutrient solution （OR = 0. 152, P = 0. 001, 95% CI： 0. 052 - 0. 446） , early use of 0. 054 - 0. 726） , early use of enema （ OR = 0.251, independent protective factors to reduce incidence of prokinetic drugs （ OR = 0. 197, P = 0. 015, 95% CI： P =0. 010, 95% CI： 0. 088 -0. 718） were the main feeding intolerance. Gonclusion At the beginning of enteral nutrition intolerance for critically ill patients, choosing whole protein of nutrient solution （except pancreatitis patients） and early use of prokinetic drugs and enema can effectively reduce the occurrence of feeding intolerance.

关 键 词：重症监护 肠内营养 喂养不耐受 医疗护理措施 

分 类 号：R181.32[医药卫生—流行病学] R459.3[医药卫生—公共卫生与预防医学]