摘要
目的：探讨导致入住ICU的创伤患者肠内营养（enteral nutrition,EN）喂养不耐受（feeding intolerance,FI）发生的危险因素。方法：对2013年7月-2015年7月期间入住某三甲医院ICU并实施EN的98例创伤患者的病历资料进行回顾,对EN耐受组与不耐受组患者的年龄、血清白蛋白、血糖、EN开始时间、ISS评分、APACHEⅡ评分、GCS评分以及颅脑损伤、多发伤、脊髓损伤、骨折、其他伤5种创伤类型进行单因素分析,并将单因素分析结果中P〈0.2的指标纳入Logistic回归分析。结果：单因素分析结果显示：血清白蛋白、血糖、EN开始时间、APACHEⅡ评分、GCS评分以及5种创伤类型之间差异有统计学意义（P〈0.05）,ISS评分P=0.108〈0.2;Logistic回归分析结果显示：血清白蛋白（OR=0.171,P=0.007,95%CI=0.048-0.616）、血糖（OR=10.493,P=0.001,95%CI=2.534-43.448）、EN开始时间（OR=11.540,P=0.004,95%CI=2.205-60.392）、GCS评分（OR=0.136,P=0.034,95%CI=0.021-0.858）、APACHEⅡ评分（OR=4.361,P=0.037,95%CI=1.096-17.350）是引起创伤患者发生FI的独立危险因素;而5种创伤类型中,除其他伤外,多发伤、脊髓损伤、骨折的患者其FI的发生率与颅脑伤患者没有统计学差异。结论：患者的血清白蛋白和GCS评分越低、血糖和APACHEⅡ评分越高、EN开始时间越晚,其发生FI的风险也越大。
Objective ：To analyze the risk factors associated with enterat feeding intolerance in traumatic patients admitted into inten- sive care unit. Methods：Retrospective analysis of 98 traumatic patients in ICU from July 2013 to July 2015 was performed, and age, serum albumin, glucose, enteral nutrition initial time, ISS score, APACHE Ⅱ score, Glasgow score and types of trauma of brain injury, multiple injury,spinal cord injury,bone fracture patients and others were compared between tolerance group and intolerance group. Those whose P value remained less than 0.2 in the single factor analysis were evaluated by multivariate logistic regression analysis. Results： Single factor analysis showed that serum albumin, glucose, enteral nutrition initial time, APACHE 1I score, Glasgow score and 5 types of trauma remained statistically significant（P〈0.05）. Besides, the P value of ISS score was less than 0.2 with its figure of 0.108. Multivariate logistic regression analysis showed that serum albumin （OR=0.171, P=0.007,95%CI=0.048 to 0.616）, glucose （OR=10.493, P=-0.001,95%CI=2.534 to 43.448）, enteral nutrition initial time（ OR= 11.540, P=0.004,95%CI=2.205 to 60.392）, Glasgow score（OR= 0.136, P=0.034,95 %CI=0.021 to 0.858 ）, APACHE Ⅱ score （ OR =4.361, P=-0.037,95%CI= 1.096 to 17.350） were the main independent risk factors of feeding intolerance. However, there was no statistical significance in the incidence of feeding intolerance among the 5 types of trauma when compared with brain injury patients, except for the other type. Conclusion ： Traumatic patients with hypopro- teinemia, hyperglycemia, delayed enteral nutrition,lower Glasgow score and higher APACHE Ⅱ score can aggravate the risk of feeding intolerance.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2016年第3期274-277,共4页
Journal of Chongqing Medical University
关键词
创伤
喂养不耐受
因素分析
trauma
feeding intolerance
factor analysis
