高营养风险机械通气病人肠内营养喂养达标与呼吸机拔管的相关性分析  

The correlation between standard enteral nutrition feeding and extubation in mechanically ventilated patients with high nutritional risk

作　　者：李嘉琪 左俊焘 徐瑶 吴翠丽[3] 叶向红 LI Jia-qi;ZUO Jun-tao;XU Yao;WU Cui-i;YE Xiang-hong(Medical College,Nanjing University,Nanjing 210093,Jiangsu,China;Graduate School,Bengbu Medical College,Bengbu 233000,Anhui,China;Affilated Jingling Hospital,Medical School of Nanjing University 210002,Jiangsu,China)

机构地区：[1]南京大学医学院,江苏南京210093 [2]蚌埠医学院研究生院,安徽蚌埠233000 [3]南京大学附属金陵医院/东部战区总医院普通外科,江苏南京210002

出　　处：《肠外与肠内营养》2023年第4期239-243,共5页Parenteral & Enteral Nutrition

摘　　要：目的:探讨高营养风险机械通气病人肠内营养是否达标与呼吸机拔管的相关性及呼吸机拔管失败的影响因素。方法:回顾性分析普通外科ICU接收的105例重症病人,将病人分为拔管成功组(n=55)和拔管失败组(n=50),比较两组病人喂养达标率、喂养不耐受状况、住院时间及28d死亡率,并分析喂养达标与呼吸机拔管的相关性。结果:两组男性占比居多,拔管成功组为41(74.65%),拔管失败组为39(78.0%),拔管成功组不耐受发生率为19(34.5%),拔管失败组不耐受发生率为18(36.0%)。拔管成功组的喂养达标率为33(60.0%),拔管失败组为7(14.0%),P=0.002;拔管成功组住院时间为26.5(13.5,63),拔管失败组为40(27.5,65),P <0.05;拔管成功组28 d死亡率为3.6%,拔管失败组为20%,P <0.05。Spearman等级相关分析显示喂养达标与呼吸机拔管成功与否呈负相关(r=-0.421,P <0.01),当喂养达标率越高时,呼吸机拔管的失败率越低。多因素Logistic回归分析表明,EN不达标是呼吸机拔管失败的独立危险因素。结论:高营养风险机械通气病人呼吸机拔管失败与EN不达标有关,导致病人住院时间延长,28 d死亡率增加。Objective:To explore the correlation between standard enteral nutrition and extubation in mechanical ventilation patients with high nutritional risk and the influencing factors of extubation failure.Methods:105 patients admitted to general surgery ICU were divided into successful extubation group(n = 55) and failed extubation group(n=50).The feeding standards,feeding intolerances,length of stay and 28 d mortality of the two groups were compared,and the correlation between feeding standards and extubation was analyzed.Results:The proportion of males in the two groups was 41(74.65%) in the successful extubation group and 39(78.0%) in the failed extubation group.The incidence of intolerance in the successful extubation group was 19(34.5%) and in the failed extubation group was 18(36.0%).The feeding attainment rate was 33(60.0%) in the successful extubation group and 7(14.0%) in the failed extubation group.The length of hospital stay was 26.5(13.5,63) in the successful extubation group,40(27.5,65) in the failed extubation group(P<0.05),and the 28d mortality was 3.6% in the successful extubation group.The extubation failure group was 20%(P<0.05).Spearman analysis showed that the feeding standard was negatively correlated with the success of extubation(r =-0.421,P<0.01).The higher the feeding standard rate was,the lower the failure rate of extubation was.Multivariate Logistic regression analysis showed that EN substandard was an independent risk factor for extubation failure.Conclusion:The failure of the extubation in mechanical ventilation patients with high nutritional risk is related to EN sub-standard,which leads to prolonged hospital stay and increased mortality at 28 days.

关 键 词：肠内营养 呼吸机拔管 高营养风险 机械通气 

分 类 号：R459.3[医药卫生—治疗学] R563.1[医药卫生—临床医学]