重症监护病房补充性肠外营养与医院感染相关性研究

Relationship between supplemental parenteral nutrition and nosocomial infection in intensive care unit

目的分析重症监护病房(ICU)补充性肠外营养(SPN)与医院感染发生的相关性。方法前瞻性收集2014年6月至2017年12月在重症监护病房住院、接受肠内营养(EN)患者的病例资料。记录所有入选患者的年龄、性别、入院时血白蛋白水平、疾病严重程度、住ICU时间、营养支持方式、热卡摄入量以及医院感染发生情况。根据营养支持方式分为单纯EN组和EN+SPN组,Cox回归分析SPN是否与ICU医院感染发生独立相关。结果共筛查278例患者,最后246例患者的病例资料纳入分析。与单纯EN组相比,EN+SPN组医院感染发生率增加(35%比10%,P<0.001)。根据SPN给予时机不同,EN+SPN组分为早期SPN(开始EN 48 h以内)和延迟SPN(开始EN 48 h后)两个亚组,Cox回归分析显示,与EN相比,SPN并不增加医院感染风险(相对危险度RR=1.10,P=0.84),延迟SPN与医院感染也无相关性(RR=0.75,P=0.42)。与医院感染发生独立相关的危险因素包括急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)(RR=1.29,P<0.001)、序贯器官衰竭评分(SOFA)(RR=1.25,P=0.003)、ICU住院时间(RR=1.06,P=0.04),机械通气时间(RR=1.45,P<0.001)、导尿管留置时间(RR=1.19,P=0.003)和中心静脉导管时间(RR=1.10,P=0.001)。结论ICU住院患者SPN并不增加医院感染发生风险。

Objective To explore the relationship between supplemental parenteral nutrition (SPN) and nosocomial infection. Methods A prospective study was conducted from June 2014 to December 2017 in intensive care unit (ICU). Age, gender, serum albumin at admission, severity of disease, length of stay in ICU, nutrition delivery approach, amounts of delivered caloric intake and occurence of nosocomial infection were recorded.Patients were classified into two groups according to nutrition delivery approach-SPN group and enteral nutrition (EN) alone group.Cox analysis were performed to identify the risk factors and assess the independent effect of SPN approach on nosocomial infection in ICU. Results 278 patients were screened and 246 were analysed in our study.Compared with EN alone group, patients delivered by SPN had a higher nosocomial infection rate (35% vs 10%, P<0.001). The SPN group were further divided into two subgroups by initiation timing, which were defined as early-initiation SPN and late-initiation SPN group respectively.Cox regression analysis showed that compared with EN, SPN did not increase the risk of nosocomial infection (relative risk RR=1.10, P=0.84), and delayed SPN was not associated with nosocomial infection (RR=0.75, P=0.42). Risk factors associated with nosocomial infection including acute physiology and chronic health evaluation systemⅡ(APACHE Ⅱ)(RR=1.29, P<0.001), sequential organ failure score (SOFA)(RR=1.25, P=0.003), length of stay in ICU (RR=1.06, P=0.04), mechanical ventilation time (RR=1.45, P<0.001), catheter indwelling time (RR=1.19, P=0.003) and central venous catheter time (RR=1.10, P=0.001). Conclusions SPN does not increase the risk of nosocomial infection in ICU inpatients.