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目的:探讨ICU患者入院2周内腹泻的流行病学特点并分析其危险因素。方法:283例我院综合ICU 2013年10月-2014年8月收住的患者纳入研究。记录患者一般资料及肠内营养情况、药物使用情况,应用多元及多层统计学方法分析腹泻危险因素。结果:共283例患者、1 603个ICU住院日纳入研究。42例(15%)患者出现腹泻,共计88个ICU住院日,发生率为5.5次/百ICU住院日。腹泻平均发生在入住ICU后第6天,89%的患者(252例)腹泻天数小于4d。腹泻的危险因素包括:超过60%目标营养量的肠内营养、使用抗生素和使用抗真菌药物[相对风险分别为1.75、3.64和2.79]。超过60%目标营养量的肠内营养合并应用抗生素或抗真菌药物[相对风险分别为4.7和11.2]腹泻风险较单因素大幅增加。结论:在综合ICU入住后前2周内腹泻发生率为15%,导致腹泻发生的危险因素为超量(>60%目标营养量)使用肠内营养、使用抗生素和/或使用抗真菌药物。
Objective: To investigate the epidemiological characteristics of diarrhea in ICU patients within 2 weeks after admission and analyze the risk factors. Methods: A total of 283 patients admitted to our ICU from October 2013 to August 2014 were included in the study. The general information of patients and enteral nutrition and drug use were recorded. The risk factors of diarrhea were analyzed by multivariate and multi-level statistical methods. RESULTS: A total of 283 patients, 1 603 ICU stay days were included in the study. Forty-two patients (15%) developed diarrhea, accounting for a total of 88 ICU days of hospitalization, with a rate of 5.5 hospitalizations per hundred ICU days of hospitalization. On average, diarrhea occurred 6 days after admission to the ICU, with 89% of the patients (252) having fewer than 4 days of diarrhea. Risk factors for diarrhea included enteral nutrition with more than 60% of target nutrient, use of antibiotics and use of antifungal drugs [relative risk 1.75, 3.64 and 2.79, respectively]. Enteral nutrition combined with antibiotics or antifungal agents in excess of 60% of targeted nutrition [relative risk of 4.7 and 11.2, respectively] increased the risk of diarrhea by more than a single factor. Conclusions: The incidence of diarrhea was 15% in the first 2 weeks after admission to the ICU, leading to the risk factors for diarrhea with enteral nutrition, antibiotics and / or the use of antifungal drugs in excess (> 60% of target nutrient).