重症急性胰腺炎患者肠内营养喂养不耐受的影响因素分析

Influencing Factors of Enteral Nutrition Intolerance in Patients with Severe Acute Pancreatitis

目的:探讨和分析影响重症急性胰腺炎患者肠内营养喂养不耐受的因素。方法:对我院2016年2月—2017年10月收治的86例重症急性胰腺炎患者的相关临床资料进行分析,对可能影响患者发生肠内营养不耐受的相关因素进行统计分析。结果:86例患者发生肠内营养喂养不耐受共52例,发生率为60.47%。在单因素分析中,镇静剂使用、肠内营养实施时间、肠内营养治疗前血清中白蛋白水平、专业护理、添加膳食纤维、腹内压和中心静脉压以及急性生理与慢性健康评分与重症急性胰腺炎患者发生肠内营养喂养不耐受密切相关(P<0.05或P<0.01),Logistics多因素分析中,急性生理与慢性健康评分、肠内营养开始时间、腹内压和中心静脉压对重症胰腺炎肠内营养喂养不耐受具有显著影响,是独立危险因素。结论:影响重症急性胰腺炎患者发生肠内营养喂养不耐受的因素较多,急性生理与慢性健康评分、肠内营养开始时间、腹内压和中心静脉压是其独立危险因素,添加膳食纤维和专业护理能减少喂养不耐受的发生,为保护性因素,临床及时认识和控制上述危险因素的发生和积极实施保护性因素对减少患者肠内营养喂养不耐受具有重要意义。

Objective To discuss and analysis the factors of affecting enteral nutrition intolerance in patients with severe acute pancreatitis. Method The clinical data of 86 patients with severe acute pancreatitis admitted to our hospital from February 2016 to October 2017 were analyzed. Statistical analysis was performed on the factors that may affect the insufficiency of enteral nutrition in patients. Result In86 cases,there were 52 cases of enteral nutrition insufficiency,and the incidence rate was 60. 47%. The use of sedatives,enteral nutrition implementation time,the level of albumin in the serum before the treatment of enteral nutrition,professional care,dietary fiber,higher APACHE II score,intra-abdominal pressure and central venous pressure were closely related to the intolerance of enteral nutrition feeding in patients with severe acute pancreatitis（ P 0. 05 or P 0. 01）. Higher APACHE II score,intra-abdominal pressure and central venous pressure and enteral nutrition implementation time were independent risk factors in logistics. Conclusion There are many factors that affect the intolerance of enteral nutrition in patients with severe acute pancreatitis. Higher APACHE II score,intra-abdominal pressure and central venous pressure and enteral nutrition implementation time are independent risk factors,dietary fiber and professional care are protective factors. It is of great significance to recognize and control the occurrence of these risk factors in a timely manner and actively implement protective factors to reduce the tolerance of enteral nutrition in patients.