摘要
目的探讨影响重型颅脑外伤患者早期肠内营养不耐受的常见危险因素。方法回顾性分析2009年6月～2011年6月年收治的354例重型颅脑外伤并行早期肠内营养患者的临床资料,分别对年龄、GCS评分、APA-CHEII评分、机械通气、幽门后喂养等17项危险因素进行单因素分析,并进行Logistic回归分析。结果152例患者发生肠内营养不耐受(42.94%),单因素分析示GCS评分、APACHEII评分、机械通气、幽门后喂养、血清白蛋白、质子泵抑制剂、镇静剂、儿茶酚胺类药物、专科护士护理与肠内营养不耐受发生相关。多因素Logistic回归分析示APACHEII评分(OR=6.787,P=0.01)、机械通气(OR=7.072,P=0.007)、镇静剂(OR=7.298,P=0.005)为肠内营养不耐受的独立危险因素,幽门后喂养(OR=0.157,P<0.01)和专科护士护理(OR=0.07,P<0.01)为保护性因素。结论APACHEII评分越高、使用机械通气和镇静剂患者容易发生肠内营养不耐受,通过幽门后喂养及专科护士护理能有效降低肠内营养不耐受发生率。
Objective To analyze the common clinical factors influencing early enteral nutrition intolerance in severe traumatic brain injury. Method The clinical data of 354 patients with severe traumatic brain injury under early enteral nutrition in department of neurosurgery in the first hospital affiliated to Soochow University from June,2009 to June,2011,were analyzed retrospectively.Univariate analysis was performed in age、GCS score、APACHEII score、mechanical ventilation,transpyloric feeding and the other factors.Logistic multivariable analysis of the factors related to the early enteral nutrition intolerance was performed for patients with severe traumatic brain injury. Result 152 patients occurred feeding intolerance（42.94%）.In univariate analysis,GCS score,APACHEII score,mechanical ventilation,transpyloric feeding、serum albumin、PPI,calmative、catecholamines、clinical nurse specialism were related to feeding intolerance.In Logistic multivariable analysis,APACHEII score（OR=6.787,P=0.01）、mechanical ventilation（OR=7.072,P=0.007）、catecholamines（OR=7.298,P=0.005）were the independent risk factors,transpyloric feeding（OR=0.157,P0.01） and clinical nurse specialism（OR=0.07,P0.01）were the protective factors. Conclusion The patients with high APACHEII score、mechanical ventilation、calmative were more prone to occur enteral nutrition intolerance.Transpyloric feeding and clinical nurse specialism could reduce the incidence of enteral nutrition intolerance.
出处
《护士进修杂志》
2012年第20期1832-1835,共4页
Journal of Nurses Training
