摘要
目的 探讨首次早期肠内营养的患者发生ICU获得性衰弱(ICU-AW)的影响因素.方法 对2021年1月至2022年12月期间在河南省人民医院急诊重症监护病房(EICU)进行首次早期肠内营养治疗的212例危重患者进行回顾性研究,根据早期肠内营养治疗期间是否发生ICU-AW分为ICU-AW组(n=76例)和非ICU-AW组(n=136例),记录两组患者的一般资料、早期肠内营养启动时间、热量-蛋白供应量及肠内营养第7天时腹内压值,分析腹内压和ICU-AW的关系,同时探讨发生ICU-AW的影响因素.结果 两组患者在年龄、机械通气、急性生理与慢性健康(APACHEⅡ)评分、血糖、进行肾脏替代治疗、使用皮质类固醇药物、平均每日热卡量、平均每日蛋白量、肠内营养不耐受、肠内营养治疗第7天时腹内压等方面,差异有统计学意义(P<0.05);其中ICU-AW组患者肠内营养第7天时的腹内压为(16.42±1.52)cmH2O均为高于非ICU-AW组(12.88±2.19)cmH2O,差异有统计学意义(P<0.05);logistic回归分析显示:发生ICU-AW的影响因素为年龄大、APACHEⅡ评分高、机械通气、使用皮质类固醇药物、平均每日热卡量及蛋白量低、发生肠内营养不耐受、肠内营养治疗第7天时腹内压高.结论 年龄大、APACHEⅡ评分高、机械通气、使用皮质类固醇药物、平均每日热卡量及蛋白量低、平均每日热卡量及蛋白量低、发生肠内营养不耐受、肠内营养治疗第7天时腹内压高是首次早期肠内营养治疗患者发生ICU-AW的危险因素,应给予有针对性的早期干预.
Abstract
Objective To explore the factors affecting intensive care unit acquired weakness(ICU-AW)in patients receiving first early enteral nutrition.Method A retrospective study was conducted on 212 patients who received first early enteral nutrition in the Emer-gency Intensive Care Unit(EICU)of our hospital from January 2021 to December 2022.The patients were divided into the ICU-AW group and non ICU-AW group based on whether ICU-AW occurred during enteral nutrition treatment.General information,early enteral nutrition initia-tion time,caloric-protein supply and intra-abdominal pressure values on day 7 of enteral nutrition treatment were recorded for the two groups of patients,then the relationship between intra-abdominal pressure and ICU-AW was analyzed and the factors affecting ICU acquired weak-ness were explored.Results There were statistical differences between the two groups in age,mechanical ventilation,acute physiological and chronic health(APACHE Ⅱ)scores,blood sugar,renal replacement therapy,corticosteroid use,average daily calorie intake,average daily pro-tein intake,intestinal nutrition intoleranceand abdominal pressure on day 7 of enteral nutrition treatment(P<0.05).The intra-abdominal pres-sure in the ICU-AW group was higher than that in the non ICU-AW group[(16.42±1.52)cmH2O vs(12.88±2.19)cmH2O],with a statisti-cally significant difference(P<0.05).Logistic regression analysis showed that the risk factors for ICU-AW were age,high APACHE Ⅱ score,mechanical ventilation,use of corticosteroids,low average daily calorie and protein intake,intestinal nutrition intoleranceand high abdominal pressure after seven days of enteral nutrition treatment.Conclusion Elderly age,high APACHE Ⅱ score,mechanical ventilation,use of corti-costeroids,low average daily calorie and protein levels,low average daily calorie and protein levels,intestinal nutrition intoleranceand high ab-dominal pressure after seven days of enteral nutrition treatment are risk factors for ICU-AW in patients undergoing initial enteral nutrition treatment.Attention should be paid and targeted early intervention should be given.
NETL
NSTL
维普
万方数据