ICU危重患者腸內(nèi)營養(yǎng)并發(fā)癥的危險因素分析
發(fā)布時間：2019-03-03 16:50
【摘要】：目的危重患者常常處于營養(yǎng)不良且高代謝的應(yīng)激狀態(tài),早期腸內(nèi)營養(yǎng)對改善營養(yǎng)供應(yīng)、維持胃腸道正常的消化吸收和免疫功能、縮短平均住院時間、降低死亡率具有重要作用,但腸內(nèi)營養(yǎng)并發(fā)癥的發(fā)生影響了腸內(nèi)營養(yǎng)的治療效果。本研究的目的在于調(diào)查重癥監(jiān)護病房(ICU)危重患者三種常見腸內(nèi)營養(yǎng)并發(fā)癥:腹瀉、便秘、反流的發(fā)生現(xiàn)狀,初步探究其相關(guān)危險因素,為采取相應(yīng)的預(yù)防性干預(yù)措施和優(yōu)化改進腸內(nèi)營養(yǎng)治療方案提供依據(jù)。方法通過文獻研究的方法并與相關(guān)臨床工作人員進行討論確定了可能引起腸內(nèi)營養(yǎng)并發(fā)癥的相關(guān)危險因素:年齡、性別、鼻飼速度、日鼻飼量、鼻飼液種類、是否患糖尿病、是否應(yīng)用抗生素、是否腎功能不全、是否禁食、是否應(yīng)用鎮(zhèn)痛劑、是否口服鉀制劑、是否機械通氣。調(diào)查分析了青島市3家三甲醫(yī)院4所ICU 2015年9月至2016年10月的759例腸內(nèi)營養(yǎng)患者的相關(guān)資料,使用SPSS19.0統(tǒng)計軟件統(tǒng)計并分析腸內(nèi)營養(yǎng)并發(fā)癥的發(fā)生情況及危險因素,利用X~2檢驗對可疑危險因素進行單因素分析,初步確定腸內(nèi)營養(yǎng)并發(fā)癥的危險因素,然后將所有的可疑危險因素引入多因素二項logistic回歸分析,篩選出腸內(nèi)營養(yǎng)并發(fā)癥的危險因素。結(jié)果267名患者發(fā)生腹瀉,發(fā)生率為35.17%;212名患者發(fā)生便秘,發(fā)生率27.93%;226名患者發(fā)生反流,發(fā)生率為29.77%。腹瀉與未腹瀉患者在應(yīng)用抗生素、年齡、禁食、口服鉀制劑,鼻飼速度、日鼻飼量等方面具有統(tǒng)計學差異;便秘與未便秘患者在鼻飼液種類、應(yīng)用鎮(zhèn)痛劑、年齡、鼻飼速度、日鼻飼量等方面具有統(tǒng)計學差異;反流與未反流患者在應(yīng)用鎮(zhèn)痛劑、機械通氣、年齡、鼻飼速度、日鼻飼量等方面有統(tǒng)計學差異。結(jié)論應(yīng)用抗生素、年齡增加、禁食、口服鉀制劑、鼻飼速度加快、日鼻飼量增加是腸內(nèi)營養(yǎng)患者腹瀉發(fā)生的危險因素;短肽或單體型腸內(nèi)營養(yǎng)液、應(yīng)用鎮(zhèn)痛劑、年齡增加是腸內(nèi)營養(yǎng)患者便秘的危險因素;機械通氣、年齡增加、鼻飼速度加快、鼻飼量增加是腸內(nèi)營養(yǎng)患者反流的危險因素。
[Abstract]:Objective severe patients are often in the stress state of malnutrition and high metabolism. Early enteral nutrition plays an important role in improving nutrition supply, maintaining normal digestive absorption and immune function of gastrointestinal tract, shortening average hospitalization time and reducing mortality. However, the complications of enteral nutrition affect the therapeutic effect of enteral nutrition. The purpose of this study was to investigate the current situation of three common enteral nutrition complications: diarrhea, constipation and reflux in critical patients with (ICU) in intensive care unit (ICU), and to explore the related risk factors. To provide the basis for taking corresponding preventive intervention measures and optimizing the improvement of enteral nutrition treatment program. Methods the related risk factors including age, sex, speed of nasal feeding, amount of nasal feeding, type of nasal feeding fluid and diabetes mellitus were identified by literature study and discussed with relevant clinical staff, and the related risk factors were age, sex, nasal feeding speed, nasal feeding volume, type of nasal feeding fluid, diabetes mellitus (DM) and diabetes mellitus (DM). Whether to use antibiotics, whether renal dysfunction, whether fasting, whether to use painkillers, whether oral potassium preparation, whether mechanical ventilation. The data of 759 patients with enteral nutrition in 4 ICU hospitals from September 2015 to October 2016 in Qingdao City were investigated and analyzed. The incidence and risk factors of complications in enteral nutrition were analyzed by using SPSS19.0 statistical software. The risk factors of complications of enteral nutrition were preliminarily determined by univariate analysis of suspicious risk factors by X-ray test, and then all the suspicious risk factors were introduced into multi-factor binomial logistic regression analysis. Risk factors for complications of enteral nutrition were screened. Results 267 patients suffered from diarrhea, the incidence of constipation was 35.17% (212 / 212), the incidence of reflux was 27.93% (226 / 226), the incidence was 29.77%. There were statistical differences in the use of antibiotics, age, fasting, oral potassium preparation, nasal feeding speed and daily nasal feeding quantity between diarrhea and non-diarrhoea patients. There were statistical differences between patients with constipation and those without constipation in the types of nasal feeding fluid, the use of painkillers, age, nasal feeding speed, daily nasal feeding volume, and so on. There were statistical differences in the use of analgesic, mechanical ventilation, age, nasal feeding speed and daily nasal feeding volume between patients with reflux and non-regurgitation. Conclusion the use of antibiotics, age, fasting, oral potassium preparation, the speed of nasal feeding is faster, and the increase of daily nasal feeding is the risk factor of diarrhea in patients with enteral nutrition. Short peptide or haplotype enteral nutrition solution, the use of analgesic, age is the risk factor of constipation in patients with enteral nutrition, mechanical ventilation, age increase, nasal feeding speed up, increase in nasal feeding is the risk factors of reflux in patients with enteral nutrition.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473
[Abstract]:Objective severe patients are often in the stress state of malnutrition and high metabolism. Early enteral nutrition plays an important role in improving nutrition supply, maintaining normal digestive absorption and immune function of gastrointestinal tract, shortening average hospitalization time and reducing mortality. However, the complications of enteral nutrition affect the therapeutic effect of enteral nutrition. The purpose of this study was to investigate the current situation of three common enteral nutrition complications: diarrhea, constipation and reflux in critical patients with (ICU) in intensive care unit (ICU), and to explore the related risk factors. To provide the basis for taking corresponding preventive intervention measures and optimizing the improvement of enteral nutrition treatment program. Methods the related risk factors including age, sex, speed of nasal feeding, amount of nasal feeding, type of nasal feeding fluid and diabetes mellitus were identified by literature study and discussed with relevant clinical staff, and the related risk factors were age, sex, nasal feeding speed, nasal feeding volume, type of nasal feeding fluid, diabetes mellitus (DM) and diabetes mellitus (DM). Whether to use antibiotics, whether renal dysfunction, whether fasting, whether to use painkillers, whether oral potassium preparation, whether mechanical ventilation. The data of 759 patients with enteral nutrition in 4 ICU hospitals from September 2015 to October 2016 in Qingdao City were investigated and analyzed. The incidence and risk factors of complications in enteral nutrition were analyzed by using SPSS19.0 statistical software. The risk factors of complications of enteral nutrition were preliminarily determined by univariate analysis of suspicious risk factors by X-ray test, and then all the suspicious risk factors were introduced into multi-factor binomial logistic regression analysis. Risk factors for complications of enteral nutrition were screened. Results 267 patients suffered from diarrhea, the incidence of constipation was 35.17% (212 / 212), the incidence of reflux was 27.93% (226 / 226), the incidence was 29.77%. There were statistical differences in the use of antibiotics, age, fasting, oral potassium preparation, nasal feeding speed and daily nasal feeding quantity between diarrhea and non-diarrhoea patients. There were statistical differences between patients with constipation and those without constipation in the types of nasal feeding fluid, the use of painkillers, age, nasal feeding speed, daily nasal feeding volume, and so on. There were statistical differences in the use of analgesic, mechanical ventilation, age, nasal feeding speed and daily nasal feeding volume between patients with reflux and non-regurgitation. Conclusion the use of antibiotics, age, fasting, oral potassium preparation, the speed of nasal feeding is faster, and the increase of daily nasal feeding is the risk factor of diarrhea in patients with enteral nutrition. Short peptide or haplotype enteral nutrition solution, the use of analgesic, age is the risk factor of constipation in patients with enteral nutrition, mechanical ventilation, age increase, nasal feeding speed up, increase in nasal feeding is the risk factors of reflux in patients with enteral nutrition.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473
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