重症监护室机械通气患者喂养不达标现状及影响因素分析

Analysis of status quo and influential factors of substandard feeding in patients with mechanical ventilation in intensive care unit

目的分析机械通气患者肠内营养喂养不达标率,并探讨其影响因素,找出目前营养支持过程中存在的问题与不足。方法本研究为病例对照研究,回顾性收集2020年6月至2022年1月入住浙江省人民医院ICU行机械通气治疗且经鼻持续肠内营养的患者作为研究对象,对其住院7 d的病历资料进行分析,根据喂养是否达标分为达标组和未达标组,比较肠内营养第7天2组患者喂养达标情况,采用Logistic回归分析喂养不达标的影响因素。结果共82例患者发生喂养不达标,发生率为57.34%(82/143)。Logistic回归分析显示,是否有并发症(OR=34.47,95%CI 9.49~125.21)和输注速度(OR=0.21,95%CI 0.08~0.57)是ICU机械通气患者喂养不达标的影响因素(P<0.05)。结论ICU机械通气患者喂养不达标率高于喂养达标率,有并发症和喂养不耐受引起的输注速度过慢是发生不达标的主要原因,建议针对患者设置个性化喂养方案,优化喂养措施,提高喂养达标率。

Objective To analyze the failure rate of enteral nutrition feeding in patients with mechanical ventilation,explore the influencing factors,and find out the existing problems and deficiencies in the process of nutrition support.Methods Patients who were admitted to the ICU of Zhejiang People′s Hospital from June 2020 to January 2022 for mechanical ventilation and continuous enteral nutrition through the nose were retrospectively collected as the research subjects.The patients were divided into a standard group and a substandard group.Comparing the feeding status of enteral nutrition patients in the two groups on the 7th day,Logistic regression was used to analyze the influencing factors of feeding substandard.Results A total of 82 patients(57.34%,82/143)had feeding failure.Logistic regression analysis showed that complications(OR=34.47,95%CI 9.49 to 125.21)and infusion speed(OR=0.21,95%CI 0.08 to 0.57)were the influencing factors of feeding failure in ICU mechanical ventilation patients(P<0.05).Conclusions The feeding failure rate of ICU mechanical ventilation patients is higher than the feeding failure rate,and the slow infusion speed caused by complications and feeding intolerance is the main reason for the failure.It is suggested to set personalized feeding program for patients,optimize feeding measures,and improve the feeding failure rate.