摘要
目的对急性重症胰腺炎患者发生肠内营养喂养不耐受的影响因素进行回顾性研究,以制定针对性措施改善患者预后。方法回顾性分析2018-03-01-2021-06-30中山市人民医院收治的75例急性重症胰腺炎患者的临床资料。所有患者均接受肠内营养支持,按照患者肠内营养喂养的耐受情况分为非耐受组(30例)和耐受组(45例)。采用SPSS 22.0对数据进行统计学分析,统计2组患者临床基本资料并进行单因素分析,同时采用多因素logistic回归分析筛选急性重症胰腺炎患者发生肠内营养喂养不耐受的独立危险因素。结果单因素分析结果显示,非耐受组患者年龄>60岁(χ^(2)=5.121,P=0.024)、开始肠内营养时间>72 h(χ^(2)=4.520,P=0.018)、腹内压水平>20 cmH_(2)O(χ^(2)=10.938,P=0.001)、血清白蛋白(ALB)水平≤25 g/L(χ^(2)=9.384,P=0.002)、中心静脉压(CVP)水平>10 cmH_(2)O(χ^(2)=7.153,P=0.007)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分>20分(χ^(2)=4.189,P=0.041)、接受机械通气治疗(χ^(2)=4.710,P=0.030)的患者占比高于耐受组,添加可溶性膳食纤维的患者占比低于耐受组,χ^(2)=4.435,P=0.035;多因素logistic回归分析结果显示,年龄>60岁(OR=3.547,95%CI:2.110~5.962,P<0.001)、开始肠内营养时间>72 h(OR=5.228,95%CI:2.135~12.804,P<0.001)、腹内压水平>20 cmH_(2)O(OR=7.645,95%CI:2.531~23.091,P<0.001)、血清ALB水平≤25 g/L(OR=3.550,95%CI:1.568~8.039,P=0.002)、APACHEⅡ评分>20分(OR=2.321,95%CI:1.464~3.679,P<0.001)均为急性重症胰腺炎患者发生肠内营养喂养不耐受的危险因素,添加可溶性膳食纤维(OR=0.213,95%CI:0.358~0.127,P<0.001)是急性重症胰腺炎患者发生肠内营养喂养不耐受的保护因素。结论年龄>60岁、开始肠内营养时间>72 h、腹内压水平>20 cmH_(2)O、血清ALB水平≤25 g/L、APACHEⅡ评分>20分均为急性重症胰腺炎患者发生肠内营养喂养不耐受的危险因素,临床上可加强以上因素的评估与预防,降低肠内营养不耐受风险。
Objective To study retrospectively the influencing factors of enteral feeding intolerance in patients with acute severe pancreatitis so as to formulate targeted measures to improve the prognosis of patients.Methods The clinical data of 75 cases with acute severe pancreatitis admitted to Zhongshan People’s Hospital from 2018-03-01 to 2021-06-30 were retrospectively selected.All patients received enteral nutrition support.According to the tolerance of enteral nutrition feeding,they were divided into non-tolerant group(30 cases)and tolerant group(45 cases).SPSS 22.0 was used to statistically analyze the data,and the basic clinical data of the two groups were statistically analyzed and univariate analysis was performed.In addition,multivariate logistic regression analysis was used to screen the independent risk factors of enteral nutrition intolerance in patients with acute severe pancreatitis.Results Univariate analysis showed that in the intolerant group,the proportion of patients aged>60 years old(χ^(2)=5.121,P=0.024),the start time of enteral nutrition>72 h(χ^(2)=4.520,P=0.018),intra-abdominal pressure level>20 cmH_(2)O(χ^(2)=10.938,P=0.001),serum albumin(ALB)level≤25 g/L(χ^(2)=9.384,P=0.002),central venous pressure(CVP)level>10 cmH_(2)O(χ^(2)=7.153,P=0.007),the score of Acute Physiology and Chronic Health II(APACHEⅡ)>20(χ^(2)=4.189,P=0.041),receiving mechanical ventilation was higher than those in the tolerant group(χ^(2)=4.710,P=0.030).However,the proportion of patients who added soluble dietary fiber was lower than that in the tolerant group(χ^(2)=4.435,P=0.035).Multivariate logistic regression analysis showed that age>60years old(OR=3.547,95%CI:2.110-5.962,P<0.001),time to start enteral nutrition>72h(OR=5.228,95%CI:2.135-12.804,P<0.001),intra-abdominal pressure>20cmH_(2)O(OR=7.645,95%CI:2.531-23.091,P<0.001),serum ALB level≤25g/L(OR=3.550,95%CI:1.568-8.039,P=0.002),APACHEⅡscore>20(OR=2.321,95%CI:1.464-3.679,P<0.001)were the risk factors of enteral nutrition feeding intolerance in patients with acute severe pancreatitis.The addition of soluble dietary fiber(OR=0.213,95%CI:0.358-0.127,P<0.001)was the protective factor of enteral nutrition feeding intolerance in patients with acute severe pancreatitis.Conclusions Age>60years old,the time to start enteral nutrition time>72hours,abdominal pressure level>20cmH_(2)O,serum ALB level≤25g/L and APACHEⅡscore>20are the risk factors of enteral nutrition feeding intolerance in patients with severe acute pancreatitis.The evaluation and prevention of the above factors should be strengthened clinically to reduce the risk of enteral nutrition intolerance.
作者
李洪广
李悦
LI Hong-guang;LI Yue(Department of Nutrition,Zhongshan People's Hospital,Guangdong Province,Zhongshan 528400,China)
出处
《社区医学杂志》
CAS
2022年第21期1215-1219,共5页
Journal Of Community Medicine
关键词
急性重症胰腺炎
肠内营养
耐受性
危险因素
acute severe pancreatitis
enteral nutrition
tolerance
risk factors
