腹部创伤病人肠内营养喂养不耐受的影响因素分析及对预后影响的研究  

Analysis of risk factors for enteral nutrition feeding intolerance in patients with abdominal trauma patients and its impact on clinical outcomes

作　　者：徐瑶 叶向红 李嘉琪 左俊焘 谢文慧 XU Yao;YE Xiang-hong;LI Jia-qi;ZUO Jun-tao;XIE Wen-hui(Graduate School,Bengbu Medical College,Bengbu 233000,Anhui,China;Department of General Surgery,General Hospital of Eastern Theater Command,PLA,Nanjing 210093,Jiangsu,China;Medical College of Nanjing University,Nanjing 210093,Jiangsu,China)

机构地区：[1]蚌埠医学院研究生院,安徽蚌埠233000 [2]东部战区总医院全军普通外科研究所,江苏南京210002 [3]南京大学医学院,江苏南京210093

出　　处：《肠外与肠内营养》2023年第6期351-356,共6页Parenteral & Enteral Nutrition

摘　　要：目的:探讨腹部创伤病人肠内营养喂养不耐受的影响因素以及对其预后的影响。方法:采用便利抽样法,对2021年12月至2022年12月就诊于东部战区总医院普通外科的117例行肠内营养治疗的腹部创伤病人的病历资料进行回顾,将病人分为肠内营养喂养耐受组与肠内营养喂养不耐受组,将单因素分析结果中P<0.05的指标纳入Logistic回归分析,得出腹部创伤病人喂养不耐受的独立危险因素,并分析喂养不耐受对腹部创伤病人预后的影响。结果:肠内营养喂养耐受组75例,肠内营养喂养不耐受组42例。单因素分析结果显示两组病人在腹腔开放、损伤严重程度评分(ISS)、肠内营养开始时间、儿茶酚胺类药物之间的差异有统计学意义(P<0.05);Logistic回归分析结果显示腹腔开放(OR=6.598,95%CI:1.349~32.256,P<0.05)、ISS(OR=5.555,95%CI:1.978~15.599,P<0.05)、肠内营养开始时间(OR=3.566,95%CI:1.174~10.835,P<0.05)是引起腹部创伤病人发生喂养不耐受的危险因素。两组病人肠内营养达标天数、ICU住院时间、总住院时间、住院费用、感染性并发症、3个月再入院率比较差异有统计学意义(P<0.05)。结论:ISS评分越高、开始肠内营养时间越迟、行腹腔开放治疗会增加喂养不耐受的发生风险,以及肠内营养喂养不耐受对预后有不利影响。Objective:To explore the risk factors for enteral feeding intolerance(FI)in patients with abdominal trauma and its impact on clinical outcomes.Methods:The medical records of 117 patients with abdominal trauma treated with enteral nutrition in a tertiary hospital from December 2021 to December 2022 were retrospectively reviewed by convenience sampling method.The patients were divided into tolerance group and intolerance group.The indicators with P<0.05 in the results of univariate analysis were included in logistic regression analysis to obtain the independent risk factors of enteral nutrition FI in patients with abdominal trauma,and to analyze the effect of enteral nutrition intolerance on the clinical outcomes.Results:There were 75 patients in tolerance group and 42 patients in intolerance group.Univariate analysis showed that there were significant differences in the presence of open abdomen,injury severity scores(ISS)score,initiation time of enteral nutrition and receipt of catecholamine drugs between the two groups(P<0.05).Logistic regression analysis showed that the presence of open abdomen(OR=6.598,95%CI 1.349~32.256,P<0.05),ISS score(OR=5.555,95%CI:1.978~15.599,P<0.05),initiation time of enteral nutrition(OR=3.566,95%CI:1.174~10.835,P<0.05)were risk factors for FI in patients with abdominal trauma.There were statistically significant differences in the days of full feeding,length of ICU stay,length of hospital stay,hospitalization expenses,incidence of infectious complications,and readmission rate within 3 months between the two groups(P<0.05).Conclusion:The higher ISS score,delayed enteral nutrition,and presence of open abdomen may increase the risk of FI,and FI has adverse effects on clinical outcomes.

关 键 词：腹部创伤 喂养不耐受 影响因素 预后 

分 类 号：R473[医药卫生—护理学] R459.3[医药卫生—临床医学]