Zhang Lei, Zhang Lulu, Zhu Xiaojie, Xu Leiming, Zhu Lin, Zhou Hai, Yang Shengkai
Department of Neurosurgery, Binhai County People's Hospital, Yancheng, Jiangsu Province, China.
Front Nutr. 2025 Feb 6;12:1443243. doi: 10.3389/fnut.2025.1443243. eCollection 2025.
Patients undergoing craniocerebral surgery often require early enteral nutrition (EN) for energy support to improve neurological prognosis. However, diarrhea is a common complication associated with EN that can affect recovery and overall prognosis. This study aims to identify the clinical risk factors for diarrhea in patients receiving EN after undergoing craniocerebral surgery.
The clinical data of patients hospitalized in the Department of Neurosurgery and Neurosurgical Intensive Care Unit of Binhai County People's Hospital were retrospectively collected from January 2021 to December 2022. Variables such as sex, age, liquid preservation, infusion duration, pipeline assessment, heating during infusion, infusion rate, post-infusion rounds, and oral care were compared between diarrhea and non-diarrhea groups. Based on the variables obtained from the LASSO regression, multivariate logistic regression was employed to analyze their association with the occurrence of diarrhea. A diagnostic nomogram was constructed to predict the probability of diarrhea in patients receiving EN after craniocerebral surgery.
According to the inclusion and exclusion criteria, 141 patients were enrolled in this study, including 50 patients in the diarrhea group and 91 patients in the non-diarrhea group. The following factors were significantly associated with diarrhea: age ≥ 70 years (OR: 2.240; 95% CI 1.110-4.520), no pipeline assessment before EN (OR: 3.807; 95% CI 1.702-7.643), no heating of EN preparations (OR: 3.188; 95% CI 1.853-6.722), no control of normal infusion rate (OR: 1.721; 95% CI 1.136-3.890), no timely post-infusion rounds after EN (OR: 2.260; 95% CI 1.454-5.075), and no oral care during EN. Multivariate logistic regression analysis identified two independent predictors of diarrhea: no heating during EN (OR: 2.135; 95% CI 1.716-5.851) and no oral care during EN (OR: 1.125; 95% CI 1.025-1.652). A diagnostic nomogram based on these two variables was developed to predict the probability of diarrhea in postoperative craniocerebral surgery patients receiving EN. The nomogram demonstrated strong predictive performance, with an AUC of 0.848 (95% CI 0.778 to 0.918).
Various factors contribute to the occurrence of diarrhea after receiving EN after craniocerebral surgery. A nomogram incorporating two independent predictors-lack of heating during EN infusion and absence of oral care-exhibited strong predictive ability and may serve as a useful tool for early risk assessment. These findings highlight the importance of incorporating heating protocols and maintaining oral hygiene during EN administration to reduce the risk of diarrhea and improve postoperative care outcomes.
接受颅脑手术的患者通常需要早期肠内营养（EN）以提供能量支持，从而改善神经功能预后。然而，腹泻是与EN相关的常见并发症，会影响康复及整体预后。本研究旨在确定颅脑手术后接受EN治疗的患者发生腹泻的临床危险因素。
回顾性收集2021年1月至2022年12月在滨海县人民医院神经外科及神经外科重症监护病房住院患者的临床资料。比较腹泻组和非腹泻组之间的性别、年龄、营养液保存、输注时长、管道评估、输注时加热、输注速度、输注后巡房及口腔护理等变量。基于LASSO回归获得的变量，采用多因素logistic回归分析其与腹泻发生的关联。构建诊断列线图以预测颅脑手术后接受EN治疗患者发生腹泻的概率。
根据纳入和排除标准，本研究共纳入141例患者，其中腹泻组50例，非腹泻组91例。以下因素与腹泻显著相关：年龄≥70岁（OR：2.240；95%CI 1.110 - 4.520）、EN前未进行管道评估（OR：3.807；95%CI 1.702 - 7.643）未对EN制剂进行加热（OR：3.188；95%CI 1.853 - 6.722）、未控制正常输注速度（OR：1.721；95%CI 1.136 - 3.890）、EN后未及时进行输注后巡房（OR：2.260；95%CI 1.454 - 5.075）以及EN期间未进行口腔护理。多因素logistic回归分析确定了腹泻的两个独立预测因素：EN期间未加热（OR：2.135；95%CI 1.716 - 5.851）和EN期间未进行口腔护理（OR：1.125；95%CI 1.025 - 1.652）。基于这两个变量开发了诊断列线图以预测颅脑手术后接受EN治疗患者发生腹泻的概率。该列线图显示出较强的预测性能，AUC为0.848（95%CI 0.778至0.918）。
多种因素导致颅脑手术后接受EN治疗后发生腹泻。包含两个独立预测因素（EN输注期间缺乏加热和未进行口腔护理）的列线图具有较强的预测能力，可作为早期风险评估的有用工具。这些发现凸显了在EN管理过程中纳入加热方案及保持口腔卫生以降低腹泻风险并改善术后护理结局的重要性。
