SAP患者早期肠内营养过程FI的预测评估

The Predictive Assessment of Feeding Intolerancein during Early Enteral Nutrition in Patients with Severe Acute Pancreatitis

目的重症急性胰腺炎(SAP)患者早期肠内营养(EEN)过程喂养不耐受(FI)预测评估的研究资料较少。旨在从SAP患者临床常用评分系统及检验指标中筛选FI的独立危险因素,以指导提前干预、改善预后。方法从2010年01月至2017年10月在西安交通大学附属汉中3201医院收治的1 177例急性胰腺炎患者中,选取ICU住院时间超过72 h且符合纳入标准的120例SAP患者,以发生FI作为主要预后观察指标,评价研究指标是否具有预测价值。结果单因素logistic回归分析显示,APACHEII评分、SOFA评分、BISAP评分、EPIC评分、CTSI评分、BMI、血糖及血乳酸与FI的发生相关(P <0.05);多因素Logistic回归分析显示,APACHEⅡ评分(OR:1.436,95%CI:1.217-1.693,P<0.001)、SOFA评分(OR:1.703,95%CI:1.284~2.257,P<0.001)、BISAP评分(OR:8.467,95%CI:2.936~24.412,P<0.001)、EPIC评分(OR:39.042,95%CI:4.538~335.885,P<0.05)、CTSI评分(OR:2.843,95%CI:1.759~4.595,P<0.001)及BMI (在5种评分模型中P<0.001),均为SAP患者EEN过程FI发生的独立危险因素。结论 5种评分及BMI对SAP患者早期肠内营养过程FI均具有预测评估价值,有助于指导提前干预,改善SAP患者的预后。

Objective There are few studies regarding the predictive assessment of Feeding Intolerance(FI) during Early Enteral Nutrition(EEN) in patients with Severe Acute Pancreatitis(SAP). This study was designed to screen for independent risk factors of FI from the commonly used scoring systems and routine laboratory testing results in SAP patients,aiming to guide early intervention and improve prognosis.Methods Of the 1177 SAP patients who were admitted to the Hanzhong 3201 Hospital affiliated to Xi’an Jiaotong University from January2010 to October 2017,a total of 120 SAP patients,admitted to the ICU great than 72 hours and met the patient inclusion criteria,were enrolled in this study. The occurrence of FI was used as the main prognostic evaluation variable and those independent variables were evaluated for their predictive values.Results Singlef actor Logistic regression analysis demonstrated that APACHEⅡ score, SOFA score, BISAP score, EPIC score, CTSI score, BMI,blood glucose, and Lactic acid were all associated with occurrence of feeding intolerance in patients with severe acute pancreatitis(P<0.05);Multivariate Logistic regression analysis demonstrated that APACHEⅡ score(OR: 1.436,95% CI: 1.217-1.693, P <0.001),SOFA score(OR: 1.703,95% CI: 1.284-2.257,P < 0.001),BISAP score(OR: 8.467,95% CI: 2.936-24.412,P< 0.001),EPIC score(OR: 39.042,95%CI: 4.538-335.885,P<0.05),CTSI score(OR: 2.843, 95%CI: 1.759-4.595,P < 0.001),and BMI(in all of five scoring systems,P<0.001) were all independent risk factors for enteral nutrition and concurrent feeding intolerance in patents with severe acutepancreatitis. Conclusion The above five scores and BMI have predictive values for EEN process in SAP patients,which help to guide early intervention and improve the prognosis in SAP patients.