急诊老年脓毒性休克患者肠内喂养不耐受情况及其影响因素分析  

Investigation of enteral feeding intolerance and its influencing factors in elderly emergency patients with septic shock

作　　者：朱丹 高素敏 卢道琴 Zhu Dan;Gao Sumin;Lu Daoqin(Department of Emergency,First People's Hospital of Huai'an City,Huai'an,Jiangsu,223300,P.R.China)

机构地区：[1]淮安市第一人民医院急诊科,江苏淮安223300

出　　处：《老年医学与保健》2024年第3期745-750,756,共7页Geriatrics & Health Care

摘　　要：目的分析急诊老年脓毒性休克患者肠内喂养不耐受(EFI)受情况及其影响因素。方法回顾性分析2020年6月—2023年6月淮安市第一人民医院急诊老年脓毒性休克患者116例的临床资料,调查其EFI情况,依据肠内喂养是否耐受将患者分为肠内喂养耐受组(n=60)和EFI(n=56),分析急诊老年脓毒性休克患者EFI的影响因素。结果急诊老年脓毒性休克患者116例,其中EFI 56例,发生率为48.28%;肠内喂养耐受组和EFI组在置管方式、主要基础疾病种类、感染部位总数、病原菌类型、APACHEⅡ评分、肠内营养方案、使用抗生素种类、使用镇痛药、低白蛋白血症、肠内营养开始时间、使用益生菌等差异有统计学意义(P<0.05);二元Logistic回归分析显示,感染部位总数≥2处(OR=2.280,95%CI:1.091~4.763)、混合感染(OR=2.651,95%CI:1.093~6.430)、APACHEⅡ评分>20分(OR=2.425,95%CI:1.034~5.689)、使用抗生素种类≥3(OR=2.102,95%CI:1.059~4.175)、低白蛋白血症(OR=2.875,95%CI:1.151~7.180)、肠内营养开始时间>7 d(OR=2.445,95%CI:1.020~5.860)均为急诊老年脓毒性休克患者EFI的危险因素(P<0.05)。结论急诊老年脓毒性休克患者EFI发生率较高,感染部位总数、病原菌类型、APACHEⅡ评分、使用抗生素种类、低白蛋白血症、肠内营养开始时间可能是急诊老年脓毒性休克EFI的影响因素。Objective To analyze enteral feeding intolerance(EFI)and its influencing factors in elderly emergency patients with septic shock.Methods The clinical data of 116 elderly emergency patients with septic shock treated in First People's Hospital of Huai'an City Huai'an from June 2020 to June 2023 were retrospectively analyzed.Their EFI status was investigated.They were divided into enteral feeding tolerance group(n=60)and EFI group(n=56)according to whether enteral feeding was tolerated.The influencing factors of EFI in elderly emergency patients with septic shock were analyzed.Results Among 116 elderly emergency patients with septic shock,EFI occurred in 56 cases(48.28%).There were significant differences in catheterization methods,types of main underlying diseases,total number of infection sites,types of pathogens,APACHEⅡ score,enteral nutrition regimens,types of used antibiotics,analgesics,hypoalbuminemia,start time of enteral nutrition and use of probiotics between the two groups(P<0.05).Binary logistic regression analysis showed that total number of infection sites≥2(OR=2.280,95%CI:1.0914.763),mixed infection(OR=2.651,95%CI:1.0936.430),APACHEⅡ score>20 points(OR=2.425,95%CI:1.0345.689),types of used antibiotics≥3(OR=2.102,95%CI:1.0594.175),hypoalbuminemia(OR=2.875,95%CI:1.1517.180)and start time of enteral nutrition>7 d(OR=2.445,95%CI:1.0205.860)were all risk factors of EFI in elderly emergency patients with septic shock(P<0.05).Conclusion The incidence of EFI is higher in elderly emergency patients with septic shock.The total number of infection sites,types of pathogens,APACHE II score,types of used antibiotics,hypoalbuminemia and start time of enteral nutrition may be the influencing factors of EFI in elderly emergency patients with septic shock.

关 键 词：老年 脓毒性休克 急诊 肠内喂养不耐受 影响因素 

分 类 号：R459.7[医药卫生—急诊医学] R459.3[医药卫生—治疗学]