临床措施对重型颅脑损伤病人肠内营养耐受性影响的回顾性研究

Effect of clinical measures on enteral nutrition tolerance in patients with severe traumatic brain injury:a retrospective study

[目的]了解重型颅脑损伤病人发生肠内营养喂养不耐受的现状,分析常用临床措施对其喂养不耐受发生的影响。[方法]回顾性分析2013年3月2019年3月入住某三级甲等医院重症监护室实施肠内营养的重型颅脑损伤病人的病例资料,依据胃肠道症状分为耐受组和不耐受组,对临床常用措施行单因素和多因素Logistic回归分析。[结果]137例病人中有82例发生喂养不耐受,发生率为59.9%。重型颅脑损伤病人使用抑酸剂(OR=4.034,P=0.008,95%CI1.444~11.268)和镇痛剂(OR=3.976,P=0.005,95%CI1.516~10.427)是肠内营养耐受性的危险因素,预防性应用促动力药(OR=0.202,P<0.001,95%CI0.089~0.456)是保护因素。[结论]重型颅脑损伤病人喂养不耐受发生率较高,喂养不耐受发生与治疗过程中使用抑酸剂和镇痛剂相关,而预防性应用促动力药有助于降低发生喂养不耐受的风险。

Objective:To explore the current occurrence of feeding intolerance during enteral nutrition in patients with severe traumatic brain injury and analyze the effect of common clinical measures on it.Methods:A retrospective analysis of severe traumatic brain injury patients who were undergoing enteral nutrition therapy and admitted to ICU in a tertiary grade A hospital from March 2013 to March 2019 was performed.According to gastrointestinal symptoms,patients were divided into tolerance group and intolerant group.The common clinical measures were analyzed by univariate and multivariate Logistic regression analysis.Results:A total of 82 of 137 patients occurred feeding intolerance,the occurrence rate was 59.9%.The use of acid inhibitors(OR=4.034,P=0.008,95%CI 1.44411.268)andanalgesics(OR=3.976,P=0.005,95%CI1.51610.427)wereriskfactorsforenteralnutritiontoleranceinpatientswith severetraumaticbraininjury,andprophylacticuseofprokineticagents(OR=0.202,P<0.001,95%CI0.0890.456)wasprotective factor.Conclusion:The incidence of feeding intolerance was higher in patients with severe traumatic brain injury.The occurrence of feeding intolerance was related to the use of acid inhibitors and analgesics in the course of treatment.However,preventive use of prokinetic agents could help reduce the risk of feeding intolerance.