不同胃残余量对ICU肠内营养患者喂养达标率的影响及危险因素分析

Effects and risk factors of different gastric residual volume on the full feeding rate of enteral nutrition patients in ICU

目的 比较ICU持续肠内营养的不同胃残余量患者喂养达标率的差异并分析喂养达标率相关影响因素。方法 选择2021年1月-2022年5月上海市第一人民医院ICU收治持续肠内营养518例患者资料回顾性分析,按照入住ICU第7天不同胃残余量进行分组,其中57例患者胃残余量≥200 mL作为达标组,另461例患者胃残余量<200 mL作为未达标组,比较2组患者ICU入住第7天喂养达标率,同时应用logistic回归模型分析影响喂养达标率的相关因素。结果 达标组患者喂养达标率为14.0%(8/57),较未达标组的27.1%(125/461)明显降低,差异有统计学意义(χ^(2)=4.548,P=0.039)。经多因素logistic回归模型分析显示,影响喂养达标的危险因素为超重(OR=0.496,P<0.001,95%CI:0.317~0.775)、肥胖(OR=0.351,P=0.020,95%CI:0.145~0.851)以及序贯器官衰竭评分(OR=0.931,P=0.023,95%CI:0.876~0.990),而保护性因素为偏瘦(OR=2.462,P=0.005,95%CI:1.315~4.609)与机械通气(OR=2.092,P=0.002,95%CI:1.279~3.421)。结论 ICU患者胃残余量≥200 mL喂养达标率虽然较胃残余量<200 mL要低,但胃残余量≥200 mL并非影响喂养达标的因素,而超重、肥胖、较高的序贯器官衰竭评分会影响ICU患者喂养达标率。

Objective To compare the difference of the full feeding rate in ICU patients with different gastric residual volume(GRV)of continuous enteral nutrition,and to analyze the related factors affecting the full feeding rate.Methods The data of 518 patients with continuous enteral nutrition admitted to the ICU of Shanghai First People's Hospital from January 2021 to May 2022 were retrospectively analyzed,and were divided into groups according to the different gastric residual volume on the 7 th day after admission to ICU,of which 57 patients with gastric residual volume≥200 mL were taken as the standard group,and 461 patients with gastric residual volume<200 mL were selected as the non-standard group.The full feeding rate of 2 groups on the 7 th day after admission to ICU was compared,and logistic regression model was used to analyze the related factors affecting the full feeding rate.Results The feeding standard rate of the standard group was 14.0%(8/57),which was significantly lower than that of the non-standard group(27.1%,125/461),and the difference was statistically significant(χ^(2)=4.548,P=0.039).The multivariate logistic regression model showed that the risk factors affecting the full feeding were overweight(OR=0.496,P<0.001,95%CI was from 0.317 to 0.775),obesity(OR=0.351,P=0.020,95%CI was from 0.145 to 0.851),and sequential organ failure score(OR=0.931,P=0.023,95%CI was from 0.876 to 0.990),while the protective factors were underweight(OR=2.462,P=0.005,95%CI was from 1.315 to 4.609)and mechanical ventilation(OR=2.092,P=0.002,95%CI was from 1.279 to 3.421).Conclusion Although the full feeding rate of ICU patients with residual volume≥200 mL is lower than that of patients with gastric residual volume<200 mL,and gastric residual volume≥200 mL is not an independent risk factor of full feeding,while overweight,obesity,and higher sequential organ failure score will affect the full feeding rate of ICU patients.