AIDS患者肠内营养支持治疗后喂养不耐受发生情况及其影响因素

Occurrence of feeding intolerance after enteral nutrition support therapy in AIDS patients and its influencing factors

目的分析AIDS患者肠内营养支持治疗后喂养不耐受发生情况及其影响因素。方法回顾性分析174例行肠内营养支持治疗的AIDS患者的临床资料,依据肠内营养支持治疗后发生喂养不耐受情况,将其分为耐受组与不耐受组。比较两组患者的一般资料、临床治疗情况、实验室检查结果、肠内营养支持治疗相关资料。采用多因素Logistic回归模型分析AIDS患者肠内营养支持治疗后发生喂养不耐受的影响因素。结果共76例患者发生喂养不耐受,发生率为43.7%。两组患者在平均动脉压、急性生理与慢性健康评估Ⅱ(APACH EⅡ)评分、机械通气治疗情况、高效联合抗反转录病毒治疗(HAART)情况,以及肠内营养支持治疗前应用激素情况、应用血管活性药物情况、抗生素使用数量、CD4^(+)T淋巴细胞计数方面比较,差异均有统计学意义(均P<0.05)。Logistic回归分析结果显示,APACH EⅡ评分>15分、机械通气治疗、HAART均是AIDS患者肠内营养支持治疗后发生喂养不耐受的危险因素,而平均动脉压>80 mmHg、肠内营养支持治疗前CD4^(+)T淋巴细胞计数>200个/μL是保护因素(均P<0.05)。结论AIDS患者肠内营养支持治疗后发生喂养不耐受的风险较高,其中APACH EⅡ评分>15分、接受机械通气治疗、接受HAART的AIDS患者发生喂养不耐受的风险增加,平均动脉压>80 mmHg、肠内营养支持治疗前CD4^(+)T淋巴细胞计数>200个/μL的AIDS患者发生喂养不耐受的风险降低。

Objective To analyze the occurrence of feeding intolerance after enteral nutrition support therapy in AIDS patients and its influencing factors.Methods The clinical data of 174 AIDS patients undergoing enteral nutrition support therapy were retrospectively analyzed,and they were assigned to tolerance group or intolerance group according to the occurrence of feeding intolerance after enteral nutrition support therapy.The general data,clinical treatment status,laboratory examination results,data related to enteral nutrition support therapy of patients were compared between the two groups.The influencing factors for the occurrence of feeding intolerance after enteral nutrition support therapy in AIDS patients were analyzed by using the multivariate Logistic regression model.Results A total of 76 patients suffered from feeding intolerance,with the incidence rate of 43.7%.There were statistically significant differences in mean arterial pressure,the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,treatment status of mechanical ventilation,status of highly active antiretroviral therapy(HAART),and the status of hormone application,status of vasoactive drugs administration,number of antibiotics used,CD4^(+)T lymphocyte counts before enteral nutrition support therapy between the two groups(all P<0.05).The results of Logistic regression analysis revealed that APACH EⅡscore>15,mechanical ventilation therapy,HAART were the risk factors for the occurrence of feeding intolerance in AIDS patients after enteral nutrition support therapy,whereas mean arterial pressure>80 mmHg,CD4^(+)T lymphocyte counts>200/μL before enteral nutrition support therapy were the protective factors(all P<0.05).Conclusion AIDS patients are at a relatively high risk of suffering from feeding intolerance after enteral nutrition support therapy,therein AIDS patients with APACH EⅡscore>15,acceptance of mechanical ventilation therapy,and acceptance of HAART have increased risk of suffering from feeding intolerance,while AIDS patients with mean arterial pressure>80 mmHg,pre-enteral nutrition support therapy CD4^(+)T lymphocyte counts>200/μL have decreased risk of suffering from feeding intolerance.