神经外科重症患者胃肠动力变化分析

Analysis of gastrointestinal motility changes in severe neurosurgical patients

目的 探讨神经外科重症患者胃肠动力变化及预测因素。方法 选取151例神经外科重症患者,每天从肠内营养开始时采用超声监测患者胃肠动力指数,每6小时动态监测1次,连续5 d。应用潜类别增长模型分析拟合神经外科重症患者胃肠动力变化轨迹,采用多元logistic回归分析不同轨迹间的预测因素。结果 共拟合出低胃肠动力组86例(57.0%)和高胃肠动力组65例(43.0%)2种胃肠动力变化轨迹。多元logistic回归分析显示,是否补充钾剂、是否使用质子泵抑制剂、是否使用冰毯及肠内营养输注速度是2种轨迹的预测因素(均P<0.05)。结论 神经外科重症患者胃肠动力有高动力和低动力2种变化轨迹,补充钾剂、使用质子泵抑制剂、使用冰毯以及肠内营养速度>50 mL/h患者更易导致胃肠功能障碍,临床需据此有效实施肠内营养,以改善胃肠动力,促进胃肠功能恢复。

Objective To explore gastrointestinal motility changes and predictors in severe neurosurgical patients.Methods A total of 151 severe neurosurgical patients were selected,and their Motility Index(MI) were monitored at the start of Enteral Nutrition(EN) by ultrasound,and they were dynamically monitored each 6 hours for continuous 5 days.The latent class growth model was conducted to analyze participants′ MI trajectories,and the predictors among different groups were analyzed by using multiple logistic regression.Results Two gastrointestinal motility trajectories were fitted:low gastrointestinal motility group(86 cases,57.0%) and high gastrointestinal motility group(65 cases,43.0%).Multiple logistic regression analysis showed that,use of potassium or not,use of proton pump inhibitors(PPI) or not,use of ice blankets or not and the speed of EN were the predictors of the two trajectories(all P<0.05).Conclusion The gastrointestinal motility in severe neurosurgical patients has high and low mobility two trajectories.Those patients using potassium,PPI and ice blankets,and with EN rate >50 mL/h are more likely to suffer from gastrointestinal dysfunction.Therefore,EN should be effectively implemented in clinic based on the above predictors,so as to improve patients′ gastrointestinal motility and promote their gastrointestinal function recovery.