ICU肠内营养相关性腹泻患者失禁性皮炎危险因素的研究

Risk factors for incontinence- associated dermatitis in ICU patients with enteral nutrition associated diarrhea

目的：探讨ICU肠内营养相关性腹泻（ENAD）患者发生失禁性皮炎的危险因素。方法采用成组匹配病例对照研究，病例组为发生失禁性皮炎的ENAD患者55例，对照组为未发生失禁性皮炎的ENAD患者55例。采用自行设计的调查表收集患者疾病因素、肛周及会阴部皮肤环境、药物因素和营养因素共4个方面的内容。结果单因素分析显示，病例组在冠心病（χ2=3.96）、灌注复合变量（χ2=7.33）、APACHEⅡ（χ2=9.87）、吸入氧浓度（Z=-2.96）、人工气道（χ2=3.91）、ENAD天数（Z=-5.45）、大便性状类型（χ2=8.46）、抗生素使用天数（χ2=5.55）、类固醇药物（χ2=11.34）、肠内营养使用天数（Z=-3.33）方面与对照组比较差异有统计学意义，P值均＜0.05；多因素分析显示，吸入氧浓度（P＜0.05，OR=1.03，OR 95%CI：1.01～1.06）、APACHE Ⅱ评分≥15分（P＜0.05，OR=3.12，OR 95%CI：1.01～9.64）和ENAD天数（P＜0.01，OR=1.64，OR 95%CI：1.29～2.10）是失禁性皮炎的独立危险因素。结论入院APACHEⅡ评分高，需要吸入高氧浓度的ENAD患者，其发生失禁性皮炎的风险高。应对该类患者进行早期监测和干预，以保护患者皮肤。

Objective To identify the risk factors associated with incontinence-associated dermatitis (IAD) in ICU patients with enteral nutrition associated diarrhea (ENAD), and to provide information for taking evidence-based preventive measures. Methods We used a case-control study to collect data. Information of the patients (n=55) and controls (n=55) were retrieved from the medical records of 2 intensive care units (ICUs). The patients with IAD and the controls without IAD were matched with age, gender and ward. Information on disease-related information, perineal environment, drug use and nutritional status were collected. Results The simple factor analysis showed that the risks of IAD were related to coronary heart disease (CHD )(χ2=3.96), composite variable for perfusion (χ2=7.33), APACHE II score (χ2=9.87), FiO2 (Z=-2.96), artificial airway (χ2=93.91), ENAD days (Z=-5.45), stool property (χ2=8.46), antibacterial drug use (χ2=5.55), steroid medicine (χ2=11.34) and enteral nutrition days(Z=-3.33), P<0.05. Logistic regression analysis showed that FiO2(P<0.05,OR=1.03, OR95%CI=1.01-1.06), APACHE Ⅱscore(P<0.05,OR=3.12, OR95%CI=1.01-9.64)and ENAD days(P<0.01,OR=1.64, OR95%CI=1.29-2.10)was independent risk factors for IAD. Conclusions The higher of FiO2, APACHE II score over 15 points and the longer of ENAD days, patients are more likely to occur IAD. Early monitoring and prevention of IAD are recommended to promote skin health.