摘要
目的 探讨重型颅脑损伤患者发生肠内营养相关性腹泻的影响因素,为降低肠内营养相关性腹泻发生率提供理论依据.方法 选取2022年1月—2024年5月在重庆市某三级甲等综合医院行肠内营养治疗的262例重型颅脑损伤患者为研究对象,根据是否发生肠内营养相关性腹泻分为腹泻组(n=102)和非腹泻组(n=160).采用单因素分析和Lasso回归筛选影响因素,通过二分类logistic回归分析重型颅脑损伤患者发生肠内营养相关性腹泻的独立影响因素.结果 2组患者在急性生理与慢性健康(APACHE Ⅱ)评分、ICU住院时长、禁食时长、是否机械通气、是否感染、抗生素使用种类数、抗生素使用时长、是否使用质子泵抑制剂、是否使用胃肠道促动力药、是否使用口服钾制剂、是否使用血管活性药物、血管活性药物使用种类数、入院时的白蛋白水平、肠内营养前的白蛋白水平14个方面上的差异具有统计学意义(P＜0.05).A-PACHE Ⅱ 评分(OR=1.117,95％CI:1.040～1.199)、机械通气(OR=2.695,95％CI:1.064～6.827)、抗生素使用种类数(OR=1.888,95％CI:1.333～2.673)、使用胃肠道促动力药(OR=2.620,95％CI:1.222～5.620)和肠内营养前的白蛋白水平(OR=0.883,95％CI:0.812～0.960)是重型颅脑损伤患者发生肠内营养相关性腹泻的独立影响因素.结论 重型颅脑损伤患者的肠内营养相关性腹泻发生率较高,临床应对APACHE Ⅱ评分高、行机械通气、使用胃肠道促动力药、使用多种抗生素的重型颅脑损伤患者采取相应的措施,以降低肠内营养相关性腹泻的发生率.
Abstract
Objective To explore the factors affecting enteral nutrition-associated diarrhea in patients with severe craniocere-bral injury,providing a theoretical basis for reducing the incidence of enteral nutrition-associated diarrhea.Methods A total of 262 patients with severe craniocerebral injury who underwent enteral nutrition treatment from January 2022 to May 2024 at a grade A tertiary hospital in Chongqing were selected as the study participants,who were assigned to diarrhea group(n=102)and non-diarrhea group(n=160)based on the occurrence of enteral nutrition-associated diarrhea.Univariate analysis and Lasso regression were used to screen influencing factors.Moreover,binary logistic regression analysis was conducted to deter-mine the independent influencing factors for enteral nutrition-associated diarrhea in patients with severe craniocerebral injury.Results Differences in Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)scores,length of ICU stay,fasting duration,use or non-use of mechanical ventilation,presence or absence of infection,types of antibiotics used,duration of antibiotic use,use or non-use of proton pump inhibitors,use or non-use of gastrointestinal prokinetic drugs,use or non-use of oral potassium preparations,use or non-use of vasoactive drugs,types of vasoactive drugs used,and albumin levels at admission and before enteral nutrition in the two groups were statistically significant(P＜0.05).APACHE Ⅱ score(OR=1.117,95％CI:1.040-1.199),mechanical ventilation(OR=2.695,95％CI:1.064-6.827),number of antibiotic types(OR=1.888,95％CI:1.333-2.673),use of gastrointestinal prokinetic drugs(OR=2.620,95％CI:1.222-5.620),and albumin levels before enteral nutrition(OR=0.883,95％CI:0.812-0.960)were independent influencing factors for enteral nutrition-associated diarrhea in patients with severe cranio-cerebral injury.Conclusion The incidence of enteral nutrition-associated diarrhea in patients with severe craniocerebral injury remains relatively high.Clinically,measures should be taken for patients with high APACHE Ⅱ scores,those on mechanical ventilation,those using gastrointestinal prokinetic drugs,and those using multiple types of antibiotics to reduce the inci-dence of enteral nutrition-associated diarrhea.
维普
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