摘要
目的 试图阐明影响危重症患者早期肠内营养达标的主要因素.方法 根据患者是否给予早期肠内营养等入选标准,回顾性分析近18个月收住重症监护病房（ICU）治疗的患者192例.依据第3天肠内营养供给能量是否达到目标营养供给量[25 kcal/（kg·d）]的60%,分为达标组和未达标组.分析比较两组患者的临床特征、实验室检查和治疗药物.通过Logistic回归分析,阐明主要影响早期肠内营养达标的因素.结果 两组胃肠道手术、儿茶酚胺类药物、镇静镇痛药物、肾脏衰竭、肠内营养后腹胀、重症胰腺炎及急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）等指标比较差异有统计学意义（P均＜0.05）.除重症胰腺炎外,将上述因素导入Logistic回归分析,显示胃肠道手术和儿茶酚胺类药物的使用对肠内营养达标具有明显的影响（P均＜0.05）,其OR值分别是7.094（95%CI 1.841～27.332）和3.076（95%CI 1.295～7.302）.结论 除重症胰腺炎患者外,胃肠道完整性的破坏和血流动力学的障碍是影响早期肠内营养达标的因素.
Objective To determine the major factors affecting the early enteral nutrition （EEN） up to goal in critically ill patients. Methods During the past 18 months in our ICU, 192 critically ill patients who met the criteria of enrollment, were included in this study. Depending on whether enteral nutrition supply was reach to 60% of nutrition goal [25 kcal/（ kg · d） ] at the third day, the patients were divided into two groups： up to goal and not up to goal. The clinical characteristics, laboratory discoveries and all kinds of interventions were compared in the two groups, and then were analysed by means of Logistic regression analysis in order to clarify the main influencing factors of early enteral nutrition up to goal. Results Gastrointestinal tract surgery,catecholamine,sedation and opioid, renal dysfunction, feed intolerance, severe acute pancreatitis （SAP） and APACHE Ⅱ score were significantly different between the two groups （P 〈 0. 05）. All of them were included in the Logistic regression analysis excepting for SAP. The results of Logistic regression analysis showed the gastrointestinal tract surgery and catecholamine had affected early enteral nutrition up to goal （P 〈 0. 05）. The OR values were 7. 094 （95% CI 1. 841 - 27. 332） and 3. 076 （95% CI 1. 295 - 7. 302） respectively. Conclusion Except SAP, the main factors affecting the early enteral nutrition up to goal were the damage of gastrointestinal tract and the hemodynamic instability.
出处
《中国急救医学》
CAS
CSCD
北大核心
2010年第6期502-504,共3页
Chinese Journal of Critical Care Medicine
