老年颅脑损伤肠内营养病人并发误吸的危险因素分析  

Risk factors for aspiration in elderly patients with traumatic brain injury undergoing enteral nutrition

作　　者：郝丹 和青森 HAO Dan;HE Qing-sen(Department of Neurocritical Surgery,Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]南阳市中心医院神经重症外科,河南473000

出　　处：《中国临床神经外科杂志》2023年第3期170-172,共3页Chinese Journal of Clinical Neurosurgery

基　　金：河南省医学科技攻关计划项目(2020062132)。

摘　　要：目的 探讨老年(≥60岁)颅脑损伤(TBI)进行肠内营养病人并发误吸的影响因素。方法 回顾性分析2021年6月至2022年6月收治的236例老年TBI的临床资料。所有病人均应用肠内营养治疗,采用多因素logistic回归模型分析误吸的影响因素。结果 肠内营养7 d内,58例(24.58%)发生误吸,178例(75.42%)未发生误吸。多因素logistic回归分析显示,APACHEⅡ评分>18分(OR=1.883;95%CI 1.347~2.633;P<0.001)、意识障碍(OR=1.793;95%CI 1.151~2.784;P=0.010)、高营养风险(OR=1.640;95%CI 1.011~2.662;P=0.045)是TBI病人肠内营养并发误吸的独立危险因素,而肠内营养时床头抬高30°~45°(OR=0.651;95%CI 0.445~0.952;P=0.027)、鼻饲置管长度>85 cm(OR=0.606;95%CI 0.434~0.845;P=0.003)是保护因素。结论 老年TBI病人进行肠内营养发生误吸风险较高,应仔细评估APACHEⅡ评分、意识、营养风险等危险因素,并采取针对性措施;建议采用头部抬高体位、深度置管,有助于降低误吸风险。Objective To investigate the risk factors for aspiration in elderly(≥60 years)patients with traumatic brain injury(TBI)undergoing enteral nutrition.Methods The clinical data of 236 elderly patients with TBI who were admitted to our hospital from June 2021 to June 2022 were retrospectively analyzed.All patients were treated with enteral nutrition,and the risk factors for aspiration were analyzed using multivariate logistic regression model.Results Within 7 days after enteral nutrition,58 patients(24.58%)had aspiration,178(75.42%)did not.Multiple logistic regression analysis showed that APACHEⅡscore>18 points(OR=1.883;95%CI 1.347~2.633;P<0.001),disturbance of consciousness(OR=1.793;95%CI 1.151~2.784;P=0.010),and high nutritional risk(OR=1.640;95%CI 1.011~2.662;P=0.045)were independent risk factors for aspiration in TBI patients,while head elevating 30°~45°during enteral nutrition(OR=0.651;95%CI 0.455-0.952;P=0.027)and length of nasal feeding tube>85 cm(OR=0.606;95%CI 0.434~0.845;P=0.003)were protective factors.Conclusions Elderly patients with TBI undergoing enteral nutrition has high risk of aspiration.APACHEⅡscore,awareness,and nutritional risk should be carefully evaluated before enteral nutrition,and targeted measures should be taken to reduce the risk of aspiration.Head elevation and deep insertion of gastrointestinal tube are recommended to help reduce the risk of aspiration.

关 键 词：颅脑损伤 老年人 肠内营养 误吸 危险因素 

分 类 号：R651.15[医药卫生—外科学]