MICU, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China (Chu YF, Meng M, Jiang JJ, Zhang JC, Ren HS, Wang CT); Longkou People's Hospital, Longkou, 265701, China(Jiang Y).
World J Emerg Med. 2010;1(1):32-6.
The widespread use of gastrointestinal bleeding prophylaxis in critically ill patients was one of the most controversial issues. Since few studies reported the incidence of gastrointestinal bleeding in mechanically ventilated patients, this study aimed to identify the incidence and risk factors related to gastrointestinal bleeding in patients undergoing mechanical ventilation for more than 48 hours.
A total of 283 ICU patients who had received mechanical ventilation for longer than 48 hours at a provincial hospital affiliated to Shandong University from January 1, 2007 to December 31, 2009 were analyzed retrospectively. Those were excluded from the study if they had a history of gastrointestinal bleeding or ulceration, recent gastrointestinal surgery, brain death and active bleeding from the nose or throat. Demographic data of the patients included patient age, diagnosis on admission, duration of ICU stay, duration of ventilation, patterns and parameters of ventilation, ICU mortality, APACHE II score, multiple organ dysfunction, and indexes of biochemistry, kidney function, liver function and coagulation function. Risk factors of gastrointestinal bleeding were analyzed by univariate analysis and multiple logistic regression analysis.
In the 242 patients who were given mechanical ventilation longer than 48 hours, the incidence of gastrointestinal bleeding was 46.7%. The bleeding in 3.3% of the patients was clinically significant. Significant risk factors were peak inspiratory pressure ≥30cmH2O, renal failure, liver failure, PLT count<50×10(9)/L and prolonged APTT. Enteral nutrition had a beneficial effect on gastrointestinal bleeding. However, the multiple logistic regression analysis revealed that the independent risk factors of gastrointestinal bleeding were as follows: high pressure ventilator setting ≥ 30cmH2O(RR=3.478, 95%CI=2.208-10.733), renal failure(RR=1.687, 95%CI = 1.098-3.482), PLT count<50×1 0(9)/L (RR=3.762, 95%CI=2.346-14.685), and prolonged APTT(RR=5.368, 95%CI=2.487-11.266). Enteral nutrition(RR=0.436, 95%CI= 0.346-0.764) was the independent protective factor.
The incidence of gastrointestinal bleeding was high in the patients who received mechanical ventilation, and bleeding usually occurred within the first 48 hours. High pressure ventilator setting, renal failure, decreased PLT count and prolonged APTT were the significant risk factors of gastrointestinal bleeding. However, enteral nutrition was the independent protective factor.
在危重症患者中广泛使用胃肠道出血预防措施是最具争议的问题之一。由于很少有研究报告机械通气患者胃肠道出血的发生率，因此本研究旨在确定机械通气超过 48 小时的患者胃肠道出血的发生率和相关危险因素。
回顾性分析 2007 年 1 月 1 日至 2009 年 12 月 31 日在山东大学附属某省级医院接受机械通气超过 48 小时的 283 例 ICU 患者。如果患者有胃肠道出血或溃疡史、近期胃肠道手术史、脑死亡和鼻腔或喉咙活动性出血，则将其排除在研究之外。患者的人口统计学数据包括患者年龄、入院诊断、ICU 住院时间、通气时间、通气模式和参数、ICU 死亡率、APACHE II 评分、多器官功能障碍以及生化、肾功能、肝功能和凝血功能指标。通过单因素分析和多因素逻辑回归分析来分析胃肠道出血的危险因素。
在 242 例接受机械通气超过 48 小时的患者中，胃肠道出血的发生率为 46.7%。其中 3.3%的患者出血具有临床意义。显著的危险因素是吸气峰压≥30cmH2O、肾衰竭、肝功能衰竭、血小板计数<50×10(9)/L 和 APTT 延长。肠内营养对胃肠道出血有有益作用。然而，多因素逻辑回归分析显示，胃肠道出血的独立危险因素如下：高压呼吸机设置≥30cmH2O（RR=3.478，95%CI=2.208-10.733）、肾衰竭（RR=1.687，95%CI=1.098-3.482）、血小板计数<50×10(9)/L（RR=3.762，95%CI=2.346-14.685）和 APTT 延长（RR=5.368，95%CI=2.487-11.266）。肠内营养（RR=0.436，95%CI=0.346-0.764）是独立的保护因素。
接受机械通气的患者胃肠道出血发生率较高，出血通常发生在通气开始后的前 48 小时内。高压呼吸机设置、肾衰竭、血小板计数减少和 APTT 延长是胃肠道出血的显著危险因素。然而，肠内营养是独立的保护因素。
