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目的了解重症医学科(ICU)内重症患者肠内喂养不足的发生率、主要原因和导致喂养不足的危险因素。方法采用前瞻性单中心研究,选择2013年10月至2013年12月广州医科大学附属第一医院重症医学科收治的需要肠内营养的患者。患者入组后记录性别、年龄以及入组时急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。其后以每天为观察单位,记录患者当日的计划肠内喂养量和实际完成肠内喂养量,以实际完成肠内喂养量/计划肠内喂养量≥65%为界,将患者当日分为肠内喂养完成组(≥65%)和肠内喂养不足组(<65%)。分别记录患者是否需要机械通气、意识水平、去甲肾上腺素使用量、镇静药物使用量、镇痛药物使用量,并记录患者肠内营养中断的原因。结果总共入组符合合标准行肠内喂养天数302 d,来源于31例患者。分为肠内喂养完成组(≥65%)249 d和肠内喂养不足组(<65%)53 d。肠内喂养不足组营养喂养中断的主要原因为腹胀(38.1%),胃潴留(26.4%),医疗操作或检查(17.3%),呕吐(11.4%),消化道出血(9.2%),鼻饲管障碍(5.8%),新出现循环动力学不稳定(4.3%),腹痛(1.4%)。两组间进行单因素比较发现喂养成功组去甲肾上腺素、丙泊酚、瑞芬太尼使用量小于喂养不足组,两组间比较有显著差异(P<0.05),将以上指标进行Logistic多因素分析发现以上三者均为肠内喂养不足的独立危险因素(P<0.05)。结论 ICU内重症患者仍存在肠内喂养不足的现象,去甲肾上腺素、丙泊酚、瑞芬太尼的使用是导致喂养不足的独立危险因素。
Objectives To understand the incidence of enteric insufficiency in critically ill patients within the intensive care unit (ICU), the main causes, and the risk factors for under-feeding. Methods A prospective, single-center study was conducted in patients enrolled in the Intensive Care Unit of the First Affiliated Hospital of Guangzhou Medical University from October 2013 to December 2013. The patients were enrolled and their sex, age, and APACHE II scores were recorded. Followed by day for the observation unit, record the patient’s day plan intestine feeding and the actual completion of enteral feeding, the actual completion of enteral feeding / planned enteral feeding ≥ 65% sector, the day the patient is divided into intestinal Within the feeding group (≥65%) and enteral feeding group (<65%). Patients were recorded whether the need for mechanical ventilation, awareness, norepinephrine use, sedation drug use, analgesic drug use, and record the reasons for the interruption of enteral nutrition. Results The total number of patients enrolled in the study was 302 days after enteral feeding, which was originated from 31 patients. Divided into enteral feeding group (≥ 65%) 249 d and enteral feeding group (<65%) 53 d. The main reasons for the disruption of nutrition feeding in the group with insufficient enteral feeding were bloating (38.1%), gastric retention (26.4%), medical procedure or examination (17.3%), vomiting (11.4%), gastrointestinal bleeding (9.2% Obstacles (5.8%), emerging circulatory instability (4.3%), abdominal pain (1.4%). The single factor comparison between the two groups found that the use of norepinephrine, propofol and remifentanil in the fed group was less than that in the fed group, there was a significant difference between the two groups (P <0.05) Factor analysis found that the above three were independent risk factors for intestinal insufficiency (P <0.05). Conclusions Intensive feeding in ICU is still under-fed. Norepinephrine, propofol and remifentanil are independent risk factors for under-feeding.