脑梗死后鼻饲病人发生腹泻的相关因素分析

Determinant factors for diarrhea after enteral tube feeding in patients with acute cerebral infarction

目的:探讨急性脑梗死后鼻饲病人发生腹泻的可能危险因素以及该危险因素对病人预后的影响。方法:回顾性分析218例急性脑梗死后鼻饲病人的临床资料。以腹泻为观察指标,对可能影响脑梗死后鼻饲病人腹泻相关指标进行单因素、多因素二分类logistic回归分析,并分析影响腹泻病人预后的相关因素以及含纤维素营养液对腹泻的影响。结果:218例脑梗死后鼻饲病人,发生腹泻85例,无腹泻133例。腹泻组病人3个月时改良RANKIN量表mRS评分高于无腹泻组(P<0.05)。单因素分析显示,入院时NIHSS评分等4个因素有统计学意义(P<0.05);多因素分析显示,使用抗生素和入院时NIHSS评分是发生腹泻的独立的风险因素,使用益生菌和肠内营养序贯治疗是发生腹泻的独立的保护因素。入院时NIHSS评分可预测影响腹泻病人的不良预后。使用含纤维素的整蛋白营养液病人腹泻发生率降低(P<0.05)。结论:脑梗死后鼻饲病人的腹泻可增加不良预后的风险。控制抗生素的使用,增加益生菌,选用含纤维素营养液和序贯营养治疗可减少腹泻发生率,提高病人康复的质量。

Objective： To explore the risk factors for diarrhea after enteral tube feeding in patients with acute cerebral infarction and the influence of the risk factors for prognosis. Methods： Clinical data of 218 patients with acute cerebral infarction who underwent enteral tube feeding were identified retrospectively. Several putative factors for diarrhea were analyzed by univariate and multivariate binary logistic regression. Among the patients with diarrhea,the determinant factors for prognosis were further analyzed. The effect of enteral feeding with or without cellulose were also analyzed. Results： Among the 218 patients,85 patients had diarrhea（ diarrhea group）,while the remaining 133 patients had no diarrhea（ non-diarrhea group）. The scores of mRS after 3 months in diarrhea group were higher than that in non-diarrhea group. By univariate analysis,4 factors including NIHSS score had significant differences（ P〈0. 05）. By multivariate analysis,probiotics use and sequential enteral nutrition were the significant independent risk factors for diarrhea in the 218 patients with acute cerebral infarction who underwent enteral tube feeding,while antibiotics use and NIHSS score were the significant independent protective factors. In the 85 patients with diarrhea（ diarrhea group）,NIHSS score was a significant independent risk factor for the poor prognosis. Among the 218 patients,the diarrheal rate was decreased significantly by enteral feeding with cellulose（ P〈0. 05）. Conclusion： Diarrhea increase the risk of poor prognosis for the patiens with acute cerebral infarction who underwent enteral tube feeding. Control of antibiotics use,increased probiotics,enteral feeding with cellulose and sequential enteral nutrition can decrease diarrhea and improve prognosis.