重症病人肠内营养中断现状及其对热卡达标的影响研究

The interruption of enteral nutrition in critically ill patients and its effect on caloric intake

目的:对重症病人肠内营养中断现状进行调查并探讨中断时间与次数对热卡达标的影响。方法:回顾性收集2022年1月至2022年11月入住南京大学医学院附属金陵医院普通外科ICU实施肠内营养的重症病人,记录病人1周内行肠内营养的相关资料,包括每日实际摄入热卡、肠内营养中断的原因、次数与时间。采用多元线性回归分析肠内营养7 d达标天数的相关因素。结果:共纳入115例重症病人,肠内营养7 d内总中断次数为136次,总中断时间为512.94 h。肠内营养中断发生频率最高的原因是外出检查(33%),其次分别是喂养不耐受(15%)与医生操作(13%);肠内营养中断的持续时间因原因而异,包括手术或术前准备10.20(8.81,18.11)h、喂养不耐受7.33(1.34,21.71)h、气道操作4.30(0.93,10.84)h等。多元线性回归分析显示肠内营养7d达标天数与中断时间和次数呈负相关(P<0.05)。结论:肠内营养中断常见的原因是外出检查、喂养不耐受、医生操作等,肠内营养中断时间越长、中断次数越多,热卡摄入不足的风险越高。医护人员尽量避免肠内营养中断事件的发生从而改善病人的临床营养结局。

Objective:To investigate the reasons,frequency and duration of enteral nutrition(EN)interruptions in critically ill patients and the effects of the interruptions on caloric intake.Methods:A retrospective study was conducted at the Department of General Surgery,Jinling Hospital,between January 2022 to November 2022.A total of 115 critically ill patients who hospitalized in the intensive care unit(ICU)and received EN were enrolled in this study.The data related to EN feedings within 1 week,including the reasons,times and duration of EN interruptions,and the daily caloric intake of the patients,were collected.Multiple linear regression analyses were done to identify the factors related to the days of reaching caloric targets within 7-day EN feedings.Results:The total times of EN interruptions in the patients were 136,and the total EN interruption duration was 512.94 h.The most common reason for EN interruption was diagnostic examination(33%),followed by feeding intolerance(15%)and other medical treatments(13%).The duration of EN interruption was varied owing to different reasons,in which the surgical operations and preoperative preparation accounted for the longest interruption time(10.20 h each patient,range:8.81-18.11 h),feeding intolerance for 7.33 h(1.34-21.71 h),and airway manipulation for 4.30 h(0.93-10.84 h).Daily EN interruption time had significant effects on the patients’caloric intake and balance per day.Multiple linear regression analysis showed that the duration and frequency of EN interruption were negatively correlated with the days of reaching caloric goal value during 7-day EN feedings(P<0.05).Conclusions:In the present study,we demonstrate that the common causes of EN interruption in critically ill patients are diagnostic testing,feeding intolerance,and medical manipulations.The duration and frequency of EN interruption have a negative impact on patients’caloric intake.The data indicate that medical and nursing staff should try to reduce the occurrence of EN interruption,which could contribute to improve the clinical outcome of EN feeding in critically ill patients.