肺癌伴糖尿病患者术后肠内营养致胃潴留危险因素分析

Analysis on the risk factors for gastric retention induced by postoperative enteral nutrition in patients with lung cancer and diabetes

目的探讨肺癌伴糖尿病患者术后肠内营养致胃潴留危险因素。方法采集2016年6月至2020年6月在湖州市中心医院进行肠内营养支持的80例肺癌伴糖尿病术后患者,根据是否发生胃潴留将其分为胃潴留组(n=24)、无胃潴留组(n=56),分析肺癌伴糖尿病患者术后肠内营养发生胃潴留的独立风险因素,建立肺癌伴糖尿病患者术后肠内营养致胃潴留发生风险列线图,并采用一致性系数(C-index)判断模型预测能力。结果胃潴留发生率为30.00%(24/80),低血压、休克、低血钾、高血糖、肠鸣音减弱、机械通气、胃动素减少可作为肺癌伴糖尿病患者术后肠内营养致胃潴留的影响因素。低血钾、高血糖、机械通气、胃动素减少均可作为肺癌伴糖尿病患者术后肠内营养致胃潴留的独立危险因素。列线图预测肺癌伴糖尿病患者术后肠内营养致胃潴留发生风险的C-index为0.687。结论肺癌伴糖尿病患者术后予以肠内营养支持阶段易导致胃潴留,其发生与多重因素相关,特别是低血钾、高血糖、机械通气、胃动素减少,针对发生胃潴留的患者进行综合护理干预,可有效维持患者血糖稳定并促进其恢复。

Objective To investigate the risk factors for gastric retention induced by postoperative enteral nutrition in patients with lung cancer and diabetes.Methods A total of 80 postoperative patients with lung cancer and diabetes who underwent enteral nutrition support in Huzhou Central Hospital from June 2016 to June 2020 were selected and divided into the gastric retention group(n=24)and the non-gastric retention group(n=56)according to the presence or absence of gastric retention.The independent risk factors for gastric retention induced by postoperative enteral nutrition in patients with lung cancer and diabetes were analyzed.Meanwhile,a nomogram of the risk of gastric retention induced by postoperative enteral nutrition in patients with lung cancer and diabetes was established,and the predictive ability of the model was determined by the concordance index(C-index).Results The incidence of gastric retention was 30.00%(24/80),and hypotension,shock,hypokalemia,hyperglycemia,reduced intestinall rumble,mechanical ventilation,and decreased motilin could be influencing factors for gastric retention induced by postoperative enteral nutrition in patients with lung cancer and diabetes.Hypokalemia,hyperglycemia,mechanical ventilation,and decreased motilin could be independent risk factors for gastric retention induced by postoperative enteral nutrition in patients with lung cancer and diabetes.The C-index(predicted by the nomogram)was 0.687 for the risk of gastric retention induced by postoperative enteral nutrition in patients with lung cancer and diabetes.Conclusion Patients with lung cancer and diabetes are prone to gastric retention during the postoperative phase of enteral nutrition support,which is associated with multiple factors,especially hypokalemia,hyperglycemia,mechanical ventilation,and decreased motilin.The comprehensive nursing intervention for patients with gastric retention can effectively stabilize their blood glucose and promote recovery.