肠瘘合并严重腹腔感染患者早期肠内营养支持治疗的安全性评估  

Evaluation of safety of early enteral nutrition in patients with severe intra-abdominal infection and intestinal fistulas

作　　者：谢天 陈晨 杨栋梁 王文越[1] 陈芬 何一宁 王鹏飞 李幼生[1] Xie Tian;Chen Chen;Yang Dongliang;Wang Wenyue;Chen Fen;He Yining;Wang Pengfei;Li Yousheng(Department of No.1 General Surgery,Shanghai Ninth People's Hospital,Shanghai Jiaotong University,Shanghai 200011,China;Clinical Research Center,Shanghai Ninth People's Hospital,Shanghai Jiaotong University,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院普通外科一科,上海200011 [2]上海交通大学医学院附属第九人民医院临床研究中心,上海200011

出　　处：《中华胃肠外科杂志》2024年第3期241-246,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金面上项目(82172119);上海交通大学医学院附属第九人民医院传染病与重症救治能力提升计划(CRZZ202002)。

摘　　要：目的评估肠瘘合并严重腹腔感染患者早期肠内营养支持治疗(EEN)的安全性。方法采用回顾性队列研究的方法。收集2017年1月1日至2020年1月1日期间,在上海交通大学医学院附属第九人民医院普通外科一科收治的204例肠瘘合并严重腹腔感染患者的临床资料。以入重症监护室(ICU)48 h内是否成功实施肠内营养支持治疗(EN),将患者分为EEN组和延迟EN(DEN)组。主要研究指标为180 d病死率;次要研究指标为腹腔出血、感染性休克、腹腔开放、血流感染、机械通气和连续性肾脏替代治疗(CRRT)事件发生率。采用logistic回归对死亡危险因素进行分析。结果两组患者在入ICU时血液学及人口学资料比较差异无统计学意义(均P>0.05)。但EEN组患者感染性休克[31.2%(15/48)比15.4%(24/156),χ^(2)=4.99,P=0.025]、CRRT[27.1%(13/48)比9.0%(14/156),χ^(2)=8.96,P=0.003]和180 d病死率[31.2%(15/48)比7.7%(12/156),χ^(2)=15.75,P<0.001]比例显著高于DEN组患者(均P<0.05)。多因素回归分析显示,年龄越大(OR=1.082,95%CI:1.027~1.139,P=0.003)、急性生理学及慢性健康状况评分(APACHEⅡ评分)越差(OR=1.189,95%CI:1.037~1.363,P=0.013)、C反应蛋白水平越高(OR=1.013,95%CI:1.004~1.023,P=0.007)和EEN(OR=8.844,95%CI:1.809~43.240,P=0.007)为肠瘘合并严重腹腔感染患者死亡的独立危险因素。结论EEN可导致肠瘘合并严重腹腔感染患者的不良事件发生,增加死亡风险。此类患者的EEN需审慎实施。Objective To evaluate the safety of early enteral nutrition(EEN)support in patients with severe intra-abdominal infection and intestinal fistulas.Methods This was a retrospective cohort study.We collected relevant clinical data of 204 patients with severe intra-abdominal infection and intestinal fistulas who had been managed in the No.1 Department of General Surgery,Shanghai Ninth People's Hospital,Shanghai Jiaotong University between 1 January 2017 and 1 January 2020.The patients were allocated to EEN or delayed enteral nutrition(DEN)groups depending on whether enteral nutrition had been instituted within 48 hours of admission to the intensive care unit.The primary outcome was 180-day mortality.Other outcomes included rates of intraperitoneal hemorrhage,septic shock,open abdominal cavity,bloodstream infection,mechanical ventilation,and continuous renal replacement therapy.Risk factors for mortality were analyzed by logistic regression.Results There were no significant differences in hematological data or other baseline characteristics between the two groups at the time of admission to the intensive care unit(all P>0.05).However,septic shock(31.2%[15/48]vs.15.4%[24/156],χ^(2)=4.99,P=0.025),continuous renal replacement therapy(27.1%[13/48]versus 9.0%[14/156],χ^(2)=8.96,P=0.003),and 180-day mortality(31.2%[15/48]vs.7.7%[12/156],χ^(2)=15.75,P<0.001)were significantly more frequent in the EEN than the DEN group(all P<0.05).Multivariate regression analysis showed that older age(OR=1.082,95%CI:1.027-1.139,P=0.003),worse Acute Physiology and Chronic Health Evaluation(APACHE)II scores(OR=1.189,95%CI:1.037-1.363,P=0.013),higher C-reactive protein(OR=1.013,95%CI:1.004-1.023,P=0.007)and EEN(OR=8.844,95%CI:1.809-43.240,P=0.007)were independent risk factors for death in patients with severe intra-abdominal infection and intestinal fistulas.Conclusion EEN may lead to adverse events and increase mortality in patients with both enterocutaneous fistulas and severe abdominal infection.EEN should be implemented with caution in s

关 键 词：肠瘘 腹腔感染 危重症 医学营养治疗 肠内营养支持治疗 早期 

分 类 号：R574[医药卫生—消化系统] R459.3[医药卫生—内科学]