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腹部创伤病人行无创氧疗期间肠内营养并发症发生的危险因素分析 被引量:2

Analysis of risk factors for complications of enteral nutrition during noninvasive oxygen therapy in abdominal trauma patients combined with lung injury
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摘要 目的:调查腹部创伤病人行无创氧疗期间肠内营养不耐受的发生现状并进行原因分析。方法:本研究为病例对照研究,选取自2018年1月至2022年5月东部战区总医院普通外科研究所重症监护病房收治的142例行无创氧疗的腹部创伤合并轻度ARDS的病人作为研究对象。通过文献研究与组内讨论确定可能引起肠内营养并发症的危险因素进行回顾性调查,采用单因素分析法和多因素Logistic回归分析影响肠内营养并发症发生的危险因素。结果:腹部创伤合并轻度ARDS病人肠内营养并发症发生例数共77.46%(110/142),其中腹胀93例(65.5%)、胃潴留63例(44.4%)、呕吐41例(28.9%),其余为腹泻33例(23.2%)、误吸3例(2.1%),HFNC组总发生率为78.9%(97/123),NIPPV组中总发生率为68.4%(13/19),肠内营养并发症发生当日的氧疗流速/CPAP及首次出现时间中位数为HFNC组(50 L/min,第2~3天),NIPPV组(7~8 cmH_(2)O,第1~2天),以是否发生肠内营养并发症为因变量行二元Logistic回归分析显示,使用镇静药、无创氧疗方式(HFNC=1,NIPPV=0)、消化液回输、无创氧疗初始高氧浓度是腹部创伤合并轻度ARDS病人行无创氧疗期间胃潴留发生的独立危险因素,无创氧疗前插管史、入ICU 24 h mNUTRIC评分是发生腹胀的独立危险因素,入ICU 24 h mNUTRIC评分、贫血是发生呕吐的独立危险因素(均P <0.05),结局对比发现,除无创氧疗后气管插管率、死亡率以外,无创氧疗总时间(发生呕吐除外)、ICU停留时间、总住院天数均有统计学差异(P <0.05)。结论:腹部创伤合并轻度ARDS病人行无创氧疗期间肠内营养并发症总体发生率较高,应重视无创氧疗和肠内营养治疗的过程兼容性,护士须针对不同的治疗阶段行动态耐受性评估与管理,重点关注高风险人群,早期识别症状发生。 Objective: To investigate the occurrence of enteral nutritional intolerance during non-invasive oxygen therapy in patients with abdominal trauma and analyze risk factors. Methods: This study was a case-control study and 142 patients with abdominal trauma and mild ARDS who underwent noninvasive oxygen therapy were enrolled in the intensive care unit of the Institute of General Surgery of the Eastern Theater General Hospital from January 2018 to May 2022. Through literature research and intra-group discussion, risk factors for enteral nutrition complications were identified retrospectively, univariate analysis and multivariate logistic regression were used to analyze the risk factors of enteral nutrition complications. Results: 77.46%(110/142) of enteral nutrition complications occurred in patients with abdominal trauma and mild ARDS, including 93 cases(65.5%) of abdominal distension, 63 cases(44.4%) of gastric retention, 41 cases(28.9%) of vomiting, 33 cases(23.2%) of diarrhea and 3 cases of aspiration(2.1%). The total incidence of HFNC group was 78.9%(97/123) and the total incidence of NIPPV group was 68.4%(13/19). The median flow rate/CPAP and time of first occurrence on the day of enteral nutrition complications was HFNC group(50 L/min,day 2 ~ 3), NIPPV group(7 ~ 8 cmH2O, day1 ~ 2 d), binary logistic regression analysis was performed with whether enteral nutrition complications occurred as the dependent variable. Use sedatives, noninvasive oxygen therapy(HFNC =1, NIPPV = 0), fistuloclysis and initial high oxygen concentration of non-invasive oxygen therapy were independent risk factor for gastric retention;history of intubation before noninvasive oxygen therapy and 24-hour mNUTRIC score for ICU admission were independent risk factors for abdominal distension;history of intubation before noninvasive oxygen therapy, 24-hour m NUTRIC score for ICU admission and anemia were independent risk factors for vomiting(all P <0.05). There were significant differences in EN tolerability score, length of stay in ICU and total length of stay(P <0.05). Conclusion: The overall incidence of enteral nutrition complications during non-invasive oxygen therapy in patients with abdominal trauma and mild ARDS was high, attention should be paid to the process compatibility of noninvasive oxygen therapy and enteral nutrition therapy. Nurses should perform dynamic tolerance assessment and management for different treatment stages, focus on high-risk groups and identify the occurrence of symptoms early.
作者 叶向红 顾璐璐 黄娴雅 张锐 YE Xiang-hong;GU Lu-lu;HUANG Xian-ya;ZHANG Rui(Research Institute of General Surgery,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Jingling Medical school of Nanjing University,Nanjing 210008,Jiangsu,China;Medical school of Nanjing University,Nanjing 210000,Jiangsu,China)
出处 《肠外与肠内营养》 CAS CSCD 北大核心 2022年第5期285-291,共7页 Parenteral & Enteral Nutrition
基金 2018年度军事医学创新工程(18CXZ040)
关键词 腹部创伤 轻度ARDS 肠内营养 无创氧疗 危险因素 Abdominal trauma Mild ARDS Enteral nutrition Non-invasive oxygen therapy Risk factors
作者简介 叶向红,主任护师,从事外科及重症护理工作。E-mail:icuyz@126.com
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