Zhu Zhu, Lei Piao, Huo Junyun, Li Tao, Yao Huan
Department of EICU, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China.
Department of Emergency Internal Medicine, Guizhou Provincial People's Hospital, Guiyang 550004, Guizhou, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Dec;36(12):1296-1300. doi: 10.3760/cma.j.cn121430-20231230-01132.
To investigate the current status and influencing factors of feeding intolerance (FI) during enteral nutrition (EN) in intensive care unit (ICU) patients.
A retrospective case-control study was conducted, including patients from two ICU wards of a tertiary hospital in Guizhou Province from July 2019 to December 2022. Clinical data were collected using a self-designed data collection form, including general information [age, gender, acute physiology and chronic health evaluation II (APACHE II)], clinical treatment (mechanical ventilation, mild hypothermia therapy), medication use (vasoactive drugs, glucocorticoids, analgesics, sedatives), EN implementation (types of EN fluids, EN methods, tube feeding rate), EN tolerance, and blood glucose status. Patients were divided into EN tolerance and EN intolerance groups based on the FI criteria. Differences in the above-mentioned indicators between the two groups were compared, and statistically significant indicators were included in a binary multivariate Logistic regression analysis to explore the independent influencing factors of FI during EN in ICU patients.
A total of 683 ICU patients were included, with 57.10% (390/683) incidence of FI during EN. The most common FI symptom was diarrhea (41.58%), followed by gastric retention, reflux, abdominal distension, nausea, abdominal pain, vomiting, and aspiration, with blood in stool being the least common (3.37%). Compared to the EN tolerance group, the EN intolerance group had significantly higher proportions of patients aged ≥60 years, undergoing mechanical ventilation, receiving analgesic and sedative medications, having hyperglycemia, using short-peptide EN fluids, receiving continuous EN, and having a feeding rate > 40 mL/h (all P < 0.05). The binary multivariate Logistic regression analysis revealed that age ≥60 years [odds ratio (OR) = 1.738, 95% confidence interval (95%CI) was 1.241-2.436, P = 0.001], continuous EN (OR = 0.534, 95%CI was 0.377-0.756, P < 0.001), use of analgesic medications (OR = 1.701, 95%CI was 1.139-2.539, P = 0.009), hyperglycemic state (OR = 2.794, 95%CI was 1.999-3.907, P < 0.001), and tube feeding rate > 40 mL/h (OR = 1.018, 95%CI was 1.009-1.027, P < 0.001) were independent risk factors for FI during EN in ICU patients.
The incidence of FI during EN in ICU patients is relatively high and influenced by age, EN methods, analgesic medications, hyperglycemic state, and tube feeding rate. Therefore, healthcare professionals need to accurately identify the risk factors for FI and actively implement effective intervention measures to reduce the incidence of FI and improve patient outcomes.
探讨重症监护病房（ICU）患者肠内营养（EN）期间喂养不耐受（FI）的现状及影响因素。
进行一项回顾性病例对照研究，纳入2019年7月至2022年12月贵州省某三级医院两个ICU病房的患者。使用自行设计的数据收集表收集临床资料，包括一般信息[年龄、性别、急性生理与慢性健康状况评分系统II（APACHE II）]、临床治疗（机械通气、亚低温治疗）、用药情况（血管活性药物、糖皮质激素、镇痛药、镇静剂）、EN实施情况（EN液种类、EN方式、管饲速度）、EN耐受性及血糖状况。根据FI标准将患者分为EN耐受组和EN不耐受组。比较两组上述指标的差异，将具有统计学意义的指标纳入二元多因素Logistic回归分析，以探讨ICU患者EN期间FI的独立影响因素。
共纳入683例ICU患者，EN期间FI发生率为57.10%（390/683）。最常见的FI症状为腹泻（41.58%），其次为胃潴留、反流、腹胀、恶心、腹痛、呕吐和误吸，便血最不常见（3.37%）。与EN耐受组相比，EN不耐受组年龄≥60岁、接受机械通气、使用镇痛和镇静药物、血糖高、使用短肽EN液、接受持续EN及管饲速度>40 mL/h的患者比例显著更高（均P<0.05）。二元多因素Logistic回归分析显示，年龄≥60岁[比值比（OR）=1.738，95%置信区间（95%CI）为1.241 - 2.436；P=0.001]、持续EN（OR = 0.534，95%CI为0.377 - 0.756；P<0.001）、使用镇痛药物（OR = 1.701，95%CI为1.139 - 2.
