神经外科重症病人肠内营养并发腹压增高的危险因素

Risk factors for intra-abdominal hypertension in critically ill neurosurgical patients after enteral nutrition

目的探讨神经外科重症病人肠内营养后发生腹压增高的危险因素。方法回顾性分析2022年6~12月神经外科监护室接受肠内营养治疗的123例神经外科重症病人的临床资料。肠内营养治疗后,在尿管末端连接压力传感器监测腹压,持续增高>12mmHg称为腹压增高。结果123例接受肠内营养的神经重症病人中,38例(30.89%)发生腹压增高。多因素logistic回归分析显示,镇静药物、喂养不耐受是神经外科重症病人肠内营养后发生腹压增高的独立危险因素(P<0.05),鼻肠管喂养、血清白蛋白正常是神经外科重症病人肠内营养后发生腹压增高的保护因素(P<0.05)。结论神经外科重症病人实施肠内营养过程中腹压增高发生率较高,镇静药物、鼻肠管喂养、血清白蛋白、喂养不耐受是神经外科重症病人肠内营养后发生腹压增高的影响因素,临床需参考这些因素制定预警方案,以改善病人的预后。

Objective To explore the risk factors for intra-abdominal hypertension(IAH)in critically ill neurosurgical patients after enteral nutrition.Methods The clinical data of 123 critically ill neurosurgical patients who received enteral nutrition treatment in the neurosurgical intensive care unit from June to December 2022 were retrospectively analyzed.After enteral nutrition treatment,a pressure sensor is connected to the end of the urinary catheter to monitor the abdominal pressure.A continuous increase of>12 mmHg is termed as IAH.Results Among the 123 critically ill neurosurgical patients receiving enteral nutrition,38 patients(30.89%)had IAH.Multivariate logistic regression analysis revealed that sedative drugs and feeding intolerance were independent risk factors for IAH after enteral nutrition in critically ill neurosurgical patients(P<0.05),while naso-intestinal tube feeding and normal serum albumin were protective factors(P<0.05).Conclusions The incidence of IAH during the implementation of enteral nutrition in critically ill neurosurgical patients is relatively high.Sedative drugs,naso-intestinal tube feeding,serum albumin,and feeding intolerance are the influencing factors for IAH after enteral nutrition in critically ill neurosurgical patients.In clinical practice,early warning plans should be formulated with reference to these factors to improve the prognosis of patients.