重症监护病房患者肠内营养不耐受的患病率及相关因素：一项回顾性研究。

Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study.

机构信息

Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.

Department of Nursing, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.

出版信息

Chin Med J (Engl). 2022 Aug 5;135(15):1814-1820. doi: 10.1097/CM9.0000000000001974.

DOI:10.1097/CM9.0000000000001974

PMID:35833658

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9521784/

Abstract

BACKGROUND

Feeding intolerance (FI) among intensive care unit (ICU) patients undergoing early continuous enteral nutrition (EN) is related to poor outcomes. This study aimed to explore the prevalence and risk factors of FI in ICU patients.

METHODS

We retrospectively enrolled 1057 patients who received early continuous EN via a nasogastric tube between January 2014 and August 2019. The prevalence of FI during the first 7 days of ICU stay was calculated, and the risk factors were investigated using multivariate logistic regression analysis.

RESULTS

The prevalence of FI during the first 7 days of ICU stay was 10.95%. FI occurred in 159 of 1057 (15.04%) patients on ICU day 2, 114 of 977 (11.67%) patients on ICU day 3, and 86 of 715 (12.03%) patients on ICU day 7. Mechanical ventilation (MV) (odds ratio [OR]: 1.928, 95% confidence interval [CI]: 1.064-3.493, P = 0.03) was an independent risk factor for FI defined by a gastric residual volume (GRV) of 200 mL and/or vomiting, and acute renal failure (OR: 3.445, 95% CI: 1.115-10.707, P = 0.032) was an independent risk factor of FI defined by a GRV of 500 mL and/or vomiting. Continuous renal replacement therapy (CRRT) was an independent predictor regardless of the FI defined by a GRV of 200 mL (OR: 2.064, 95% CI: 1.233-3.456, P = 0.006) or 500 mL (OR: 6.199, 95% CI: 2.108-18.228, P = 0.001) in the ICU patients.

CONCLUSIONS

FI occurs frequently in early ICU days, especially in patients receiving MV and CRRT. However, further investigation of a consensus definition of FI and risk factors is still warranted in future studies.

摘要

背景

接受早期持续肠内营养（EN）的重症监护病房（ICU）患者的喂养不耐受（FI）与不良结局有关。本研究旨在探讨 ICU 患者 FI 的患病率和危险因素。

方法

我们回顾性纳入了 2014 年 1 月至 2019 年 8 月期间通过鼻胃管接受早期连续 EN 的 1057 例患者。计算 ICU 住院期间前 7 天 FI 的患病率，并使用多变量 logistic 回归分析调查危险因素。

结果

ICU 住院期间前 7 天 FI 的患病率为 10.95%。在 ICU 第 2 天，1057 例患者中有 159 例（15.04%）发生 FI，在 ICU 第 3 天，977 例患者中有 114 例（11.67%）发生 FI，在 ICU 第 7 天，715 例患者中有 86 例（12.03%）发生 FI。机械通气（MV）（比值比[OR]：1.928，95%置信区间[CI]：1.064-3.493，P=0.03）是胃残留量（GRV）为 200 mL 和/或呕吐的 FI 的独立危险因素，急性肾损伤（OR：3.445，95%CI：1.115-10.707，P=0.032）是 GRV 为 500 mL 和/或呕吐的 FI 的独立危险因素。连续肾脏替代治疗（CRRT）是一个独立的预测因素，与 GRV 为 200 mL（OR：2.064，95%CI：1.233-3.456，P=0.006）或 500 mL（OR：6.199，95%CI：2.108-18.228，P=0.001）定义的 FI 无关。