重型颅脑损伤患者肠内营养相关性腹泻发生现状及影响因素分析  

Incidence of enteral nutrition-related diarrhea in patients with severe craniocerebral injury and its influencing factors

作　　者：高欣 孔祥润 陈云霞 梁欠欠 高子恒 王冠宇 王丽 GAO Xin;KONG Xiangrun;CHEN Yunxia;LIANG Qianqian;GAO Ziheng;WANG Guanyu;WANG Li(ICU,Department of Neurology,Henan Provincial People's Hospital/Henan Provincial Key Laboratory of Nursing Medicine/People's Hospital of Zhengzhou University,Zhengzhou,Henan 450000,China;School of Nursing,Zhengzhou University,Zhengzhou,Henan 450000,China)

机构地区：[1]河南省人民医院神经内科ICU/河南省护理医学重点实验室/郑州大学人民医院,河南郑州450000 [2]郑州大学护理学院,河南郑州450000

出　　处：《中华神经外科疾病研究杂志》2025年第2期83-87,共5页Chinese Journal of Neurosurgical Disease Research

基　　金：河南省医学科技攻关计划项目(LHGJ20230054)。

摘　　要：目的探讨重型颅脑损伤患者肠内营养相关性腹泻发生情况及影响因素,为重型颅脑损伤患者肠内营养支持提供指导。方法选取2020年1月至2024年6月在河南省人民医院行肠内营养支持的104例重型颅脑损伤患者作为研究对象,统计其肠内营养相关性腹泻发生情况。收集所有纳入患者的临床资料,分析重型颅脑损伤患者发生肠内营养相关性腹泻的影响因素。结果本研究104例重型颅脑损伤患者,39例发生肠内营养相关性腹泻,发生率为37.50%(39/104)。单因素分析结果发现,与未发生肠内营养相关性腹泻的患者相比,发生肠内营养相关性腹泻的患者的急性生理与慢性健康(APACHEⅡ)评分、低蛋白血症人数占比、术后禁食时长>48 h人数占比以及机械通气人数占比均上升(P<0.05),两组年龄、性别、体质量指数(BMI)、格拉斯哥昏迷量表(GCS)评分、致伤因素、损伤类型、肠内营养输注方式、肠内营养制剂种类比较无统计学差异(P>0.05)。多因素分析显示:APACHEⅡ评分上升(OR=2.565,95%CI:1.422~4.627)、低蛋白血症(OR=2.149,95%CI:1.220~3.786)、术后禁食时长>48 h(OR=2.261,95%CI:1.201~4.259)、机械通气(OR=2.071,95%CI:1.091~3.931)是重型颅脑损伤患者发生肠内营养相关性腹泻的危险因素(P<0.05)。结论重型颅脑损伤患者肠内营养相关性腹泻发生率较高,APACHEⅡ评分上升、低蛋白血症、术后禁食时长超过48 h和机械通气是这类患者发生肠内营养相关性腹泻的主要危险因素。Objective To explore the incidence and its influencing factors of enteral nutrition-related diarrhea in patients with severe craniocerebral injury,and to provide guidance for their enteral nutrition support.Methods A total of 104 patients with severe craniocerebral injury who received enteral nutrition in Henan Provincial People's Hospital from January 2020 to June 2024 were selected,and the incidence of enteral nutrition-related diarrhea was counted.The clinical data of all the included patients were collected,and the influencing factors of enteral nutrition-related diarrhea in patients with severe craniocerebral injury were analyzed.Results Enteral nutrition-related diarrhea occurred in 39 of the 104 patients with severe craniocerebral injury,and the incidence was 37.50%(39/104).The results of univariate analysis showed that compared with patients without enteral nutrition-related diarrhea,the APACHEⅡscore,the proportion of patients with hypoproteinemia,the proportion of patients with postoperative fasting time>48 hours,and the proportion of patients with mechanical ventilation in patients with enteral nutrition-related diarrhea increased(P<0.05).There were no significant differences in age,gender,BMI,GCS score,injury factors,injury types,enteral nutrition infusion methods,and types of enteral nutrition preparations between the two groups(P>0.05).Multivariate analysis showed that increased APACHEⅡscore(OR=2.565,95%CI:1.422-4.627),hypoproteinemia(OR=2.149,95%CI:1.220-3.786),postoperative fasting time>48h(OR=2.261,95%CI:1.201-4.259),mechanical ventilation(OR=2.071,95%CI:1.091-3.931)were risk factors for enteral nutrition-related diarrhea in patients with severe craniocerebral injury(P<0.05).Conclusions The incidence of enteral nutrition-related diarrhea is higher in patients with severe craniocerebral injury.The increase of APACHEⅡscore,hypoproteinemia,fasting for more than 48 hours after surgery and mechanical ventilation are the main risk factors for enteral nutrition-related diarrhea in these patients.

关 键 词：重型颅脑损伤 肠内营养 腹泻 影响因素 

分 类 号：R651.15[医药卫生—外科学]