重症监护病房患者肠内营养相关性腹泻影响因素分析及干预对策

Analysis of factors affecting enteral nutrition-associated diarrhea in patients in intensive care units and countermeasures for intervention

目的探讨重症监护病房患者肠内营养相关性腹泻的影响因素及干预对策。方法采取便利抽样法,回顾性选取2018年1月至2022年1月温州医科大学附属第二医院重症监护病房肠内营养患者,采用自行设计调查表收集ICU肠内营养患者的一般资料,并根据是否发生腹泻分为腹泻组(n=31)与未腹泻组(n=149),通过Logistic回归分析探讨腹泻发生的影响因素。结果180例ICU肠内营养患者中,31例发生腹泻,发生率为17.22%。单因素分析显示,两组患者在近5d内行腹部手术、低血清白蛋白水平(<25g/L)、使用抗生素超过2周、制剂的日用量≥1200ml、制剂未逐渐增量、肠内营养治疗前禁食、口服钾制剂的比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,近5d内行腹部手术、使用抗生素超过2周、制剂未逐渐增量、肠内营养治疗前禁食是ICU患者肠内营养相关性腹泻的独立危险因素(P<0.05)。结论ICU肠内营养患者腹泻发生率较高,近5d内行腹部手术、使用抗生素超过2周、制剂未逐渐增量、肠内营养治疗前禁食为影响腹泻发生的主要独立危险因素,临床医护人员可针对危险因素予合理干预并改善预后。

Objective To exploring the influencing factors enteral nutrition-associated diarrhea and intervention countermeasures in intensive care unit patients.Methods A convenience sampling method was used to retrospectively select enteral nutrition patients in intensive care unit(ICU)from January 2018 to January 2022,and a self-designed questionnaire was used to collect general information on enteral nutrition patients in the ICU,and they were divided into diarrhea group(n=31)and non-diarrhea groups(n=149)according to whether diarrhea occurred,and the factors influencing the occurrence of diarrhea were explored by Logistic regression.Results Among 180 patients with enteral nutrition in ICU,31 cases of diarrhea occurred,with an incidence of 17.22%.Univariate analysis showed that the differences between the two groups of patients with abdominal surgery within the last 5 days,low serum albumin level(<25g/L),use of antibiotics for more than two weeks,daily dosage of the preparation≥1200ml,preparation not gradually increased,fasting before enteral nutrition therapy,and oral potassium preparation were statistically significant(P<0.05).Logistic regression analysis showed that abdominal surgery within the last 5 days,use of antibiotics for more than two weeks,preparation not gradually increased,and fasting before enteral nutrition therapy were independent risk factors for enteral nutrition-associated diarrhea in ICU patients(P<0.05).Conclusion The incidence of diarrhea in ICU enteral nutrition patients is high.Abdominal surgery within the last 5 days,use of antibiotics for more than 2 weeks,failure to gradually increase the amount of preparation,and fasting before enteral nutrition treatment are the main independent risk factors affecting the occurrence of diarrhea,and clinical caregivers can provide reasonable interventions to address the risk factors and improve the prognosis.