信息化引导下肠内营养相关性腹泻处置流程在慢性阻塞性肺疾病持续无创辅助通气患者中的应用效果分析——一项前后对照混合性队列研究

Effect analysis of information-guided enteral nutrition-associated diarrhea treatment process in patients with chronic obstructive pulmonary disease undergoing continuous non-invasive assisted ventilation:a mixed cohort study of pre-and post-control

目的探讨信息化引导下肠内营养相关性腹泻(ENAD)处置流程在慢性阻塞性肺疾病(COPD)持续无创辅助通气患者中的应用效果。方法采用前后对照混合性队列研究方法,选择2021年7月1日至2022年7月31日湖州市第一人民医院急诊重症监护病房(ICU)收治的需要持续无创辅助通气治疗的39例COPD患者。以2022年1月28日完成危重患者ENAD管理软件研发为时间节点,2021年7月1日至2022年1月28日收治的20例患者作为对照组,2022年1月29日至7月31日收治的19例患者为观察组。两组患者接受一致的肠内营养支持治疗方案。对照组实施以肠内营养不耐受处置流程为核心的常规ENAD处置流程;观察组在对照组的基础上实施信息化引导下ENAD处置流程,通过系统软件主动抓取ENAD患者信息,提醒医护团队完善腹泻相关检查并提供备选处置方案。比较两组患者止泻时间、喂养中断率及针对腹泻干预7 d后能量和蛋白质摄入量、血生化指标、血电解质代谢异常发生率、日持续无创辅助通气时间与气管插管情况。结果两组患者除基础脉率存在差异外,在性别分布、年龄及入院时生命体征、基础营养状态、动脉血气分析、血生化等方面差异均无统计学意义,具有可比性。当出现ENAD后,观察组患者较对照组更早获得止泻〔d:3.00(2.00,3.25)比4.00(3.00,5.00),P<0.01〕,且喂养中断率明显低于对照组〔10.53%(2/19)比65.00%(13/20),P<0.01〕;针对腹泻干预7 d后,观察组患者能量摄入量显著高于对照组〔kJ·kg^(-1)·d^(-1):66.28(43.34,70.36)比47.88(34.60,52.32),P<0.01〕,血红蛋白(Hb)、白蛋白(Alb)、前白蛋白(PAB)水平均显著高于对照组〔Hb(g/L):119.79±10.04比110.20±7.75,Alb(g/L):36.00(33.75,37.25)比31.00(30.00,33.00),PAB(mg/L):155.79±25.78比140.95±14.97,均P<0.05〕,日持续无创辅助通气时间较对照组明显缩短〔h:14(12,16)比16(14,18),P<0.01〕,动脉血二氧化碳分压(PaCO_(2))较对照组明显降低〔mmHg(1 mmHg≈0.133 kPa):66.00(62.00,70.00)比68.00(67.50,70.05),P<0.05〕;而两组患者蛋白质摄入量、血电解质代谢异常发生率、因急性呼吸衰竭需要气管插管发生率等差异均无统计学意义。结论信息化引导下ENAD处置流程可使发生ENAD的COPD持续无创辅助通气患者更早获得止泻,并能够改善患者蛋白质能量代谢与呼吸功能。

Objective To clarify the application effect of information-guided enteral nutrition-associated diarrhea(ENAD)management process in patients with chronic obstructive pulmonary disease(COPD)undergoing non-invasive assisted ventilation.Methods A mixed cohort study of pre-and post-control was conducted.Thirty-nine patients with COPD who were admitted to the emergency intensive care unit(ICU)of Huzhou First People's Hospital from July 1,2021 to July 31,2022 were enrolled.Taking the completion of the software development of ENAD management software for critically ill patients on January 28,2022 as the time node,20 patients admitted from July 1,2021 to January 28,2022 were set as the control group,and 19 patients admitted from January 29 to July 31,2022 were set as the observation group.The two groups of patients received the same enteral nutrition support treatment,and the control group implemented the conventional ENAD treatment process with enteral nutrition intolerance disposal process as the core.On the basis of the control group,the observation group implemented the information-guided ENAD treatment process,and the system software actively captured the information of ENAD patients and reminded the medical team to improve the patient's diarrhea-related examination and provide alternative treatment plans.The duration of antidiarrhea,feeding interruption rate,and energy and protein intake,blood biochemical indexes,incidence of abnormal blood electrolyte metabolism,daily continuous non-invasive assisted ventilation and endotracheal intubation after 7 days of targeted diarrhea intervention were compared between the two groups.Results Except for the basal pulse rate,there were no significant differences in gender distribution,age,and vital signs,basic nutritional status,arterial blood gas analysis and blood biochemistry at admission between the two groups,indicating comparability between the two groups.When ENAD occurred,the patients in the observation group obtained earlier cessation of diarrhea than those in the control group[days:3.00(2.00,3.25)vs.4.00(3.00,5.00),P<0.01],and the feeding interruption rate was significantly lower than that in the control group[10.53%(2/19)vs.65.00%(13/20),P<0.01].After 7 days of diarrhea intervention,the energy intake of the observation group was significantly higher than that of the control group[kJ·kg^(-1)·d^(-1):66.28(43.34,70.36)vs.47.88(34.60,52.32),P<0.01],the levels of hemoglobin(Hb),albumin(Alb)and serum prealbumin(PAB)were significantly higher than those in the control group[Hb(g/L):119.79±10.04 vs.110.20±7.75,Alb(g/L):36.00(33.75,37.25)vs.31.00(30.00,33.00),PAB(mg/L):155.79±25.78 vs.140.95±14.97,all P<0.05],the daily continuous non-invasive assisted ventilation duration was significantly shorter than that of the control group[hours:14(12,16)vs.16(14,18),P<0.01],and the arterial partial pressure of carbon dioxide(PaCO_(2))was significantly lower than that of the control group[mmHg(1 mmHg≈0.133 kPa):66.00(62.00,70.00)vs.68.00(67.50,70.05),P<0.05].However,there were no significant differences in protein intake,incidence of abnormal electrolyte metabolism,and incidence of endotracheal intubation due to acute respiratory failure between the two groups.Conclusion The information-guided ENAD treatment process can enable the COPD patients undergoing continuous non-invasive assisted ventilation who experience ENAD to receive earlier cessation of diarrhea,and improve the protein energy metabolism and respiratory function of the patients.