摘要
目的探讨卒中患者肠内营养喂养不耐受(enteral nutrition feeding intolerance,ENFI)的影响因素。方法选取建库至2024年12月中国知网、万方、维普、Cochrane library、Embase、PubMed、Web of Science、SinoMed等数据库发表的探讨卒中患者ENFI的中英文队列研究和病例对照研究。对所有文献进行整理和分析,使用纽卡斯尔-渥太华量表(Newcastle-Ottawa-scale,NOS)评估文献质量,并对卒中患者ENFI的影响因素进行meta分析。结果共检索文献1435篇,最终纳入文献15篇,涉及2831例患者;15篇文献NOS评分≥7分,均为高质量文献。Meta分析结果显示,卒中患者ENFI的发生率为42%(95%CI:34%~49%,P<0.05,I^(2)=73%)。年龄≥60岁(OR=3.66,95%CI:2.57~5.22,P<0.001,I^(2)=40%)、血清ALB<35 g/L(OR=6.39,95%CI:4.14~9.84,P<0.001,I^(2)=0)、使用抗生素(OR=3.40,95%CI:2.56~4.53,P<0.001,I^(2)=30%)、使用血管活性药物(OR=3.27,95%CI:2.02~5.30,P<0.001,I^(2)=0)、亚低温治疗(OR=3.57,95%CI:1.59~7.98,P=0.002,I^(2)=0)、机械通气(OR=3.02,95%CI:2.28~4.01,P<0.001,I^(2)=0)、急性生理和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分越高(OR=3.07,95%CI:1.89~4.97,P<0.001,I^(2)=32%)、美国国立卫生研究院卒中量表(National Institutes Health Stroke Scale,NIHSS)评分越高(OR=1.10,95%CI:1.05~1.16,P<0.001,I^(2)=49%)、格拉斯哥昏迷评分(Glasgow coma scale,GCS)越低(OR=2.07,95%CI:1.18~3.63,P=0.01,I^(2)=72%)、肠道感染(OR=3.24,95%CI:1.25~8.40,P=0.02,I^(2)=64%)、喂养速度>100 ml/H(OR=3.77,95%CI:1.73~8.23,P<0.001,I^(2)=60%)的卒中患者,其ENFI的发生风险较高,添加益生菌(OR=0.36,95%CI:0.25~0.53,P<0.001,I^(2)=0)和添加膳食纤维(OR=0.24,95%CI:0.14~0.40,P<0.001,I^(2)=0)的卒中患者,ENFI的发生风险较低。结论ENFI受疾病严重程度、临床干预措施等多方面影响。临床实践中应重点识别高龄、低蛋白血症、抗生素使用、机械通气等因素,并积极采用益生菌与膳食纤维等保护性干预措施。建议医护人员结合胃残余量、腹部体征及相关实验室指标,对高风险患者实施早期、动态评估与个体化营养管理,以有效预防ENFI的发生。
Objective To explore the influencing factors of enteral nutrition feeding intolerance(ENFI)in patients with stroke.Methods Cohort studies and case-control studies,both in Chinese and English,investigating ENFI in patients with stroke were retrieved from databases including CNKI,Wanfang Data,Wipro Database,Cochrane Library database,Embase,PubMed,Web of Science,and SinoMed from database inception to December 2024.After screening,eligible studies were systematically reviewed.The Newcastle-Ottawa-scale(NOS)was used to assess the methodological quality of the included studies,and a meta-analysis was conducted to analyze the influencing factors of ENFI in patients with stroke.Results A total of 1435 studies were retrieved,and 15 studies involving 2831 patients were finally included.All the 15 studies achieved a NOS score more than seven points,indicating high methodological quality.The meta-analysis results showed that the incidence rate of ENFI in the patients was 42%(95%CI:34%-49%,P<0.05,I^(2)=73%).The meta-analysis identified several significant risk factors for ENFI which included age≥60 years(OR=3.66,95%CI:2.57-5.22,P<0.001,I^(2)=40%),serum ALB<35 g/L(OR=6.39,95%CI:4.14-9.84,P<0.001,I^(2)=0),antibiotic use(OR=3.40,95%CI:2.56-4.53,P<0.001,I^(2)=30%),vasopressor use(OR=3.27,95%CI:2.02-5.30,P<0.001,I^(2)=0),mild hypothermia therapy(OR=3.57,95%CI:1.59-7.98,P=0.002,I^(2)=0),mechanical ventilation(OR=3.02,95%CI:2.28-4.01,P<0.001,I^(2)=0),higher acute physiology and chronic health evaluationⅡ(APACHEⅡ)score(OR=3.07,95%CI:1.89-4.97,P<0.001,I^(2)=32%),higher National Institutes Health Stroke Scale(NIHSS)score(OR=1.10,95%CI:1.05-1.16,P<0.001,I^(2)=49%),lower GCS score(OR=2.07,95%CI:1.18-3.63,P=0.01,I^(2)=72%),intestinal infection(OR=3.24,95%CI:1.25-8.40,P=0.02,I^(2)=64%),and feeding rate>100 ml/h(OR=3.77,95%CI:1.73-8.23,P<0.001,I^(2)=60%).Conversely,patients who received probiotic supplementation(OR=0.36,95%CI:0.25-0.53,P<0.001,I^(2)=0)or dietary fiber supplementation(OR=0.24,95%CI:0.14-0.40,P<0.001,I^(2)=0)had a significantly lower risk of ENFI.Conclusions The development of ENFI in stroke patients is influenced by multiple factors,including disease severity and clinical interventions.In clinical practice,priority should be given to identifying high-risk factors such as advanced age,hypoalbuminemia,antibiotic use,and mechanical ventilation.Meanwhile,protective interventions including probiotic and dietary fiber supplementation should be actively implemented.It is recommended that healthcare providers conduct early and dynamic assessments combined with nutritional management for high-risk patients,incorporating gastric residual volume,abdominal sign and relevant laboratory indicators,to effectively prevent the occurrence of ENFI.
作者
王圳洋
孙红
常红
胡慧秀
刘露凝
王玉玺
杨亭
姚辉
Wang Zhenyang;Sun Hong;Chang Hong;Hu Huixiu;Liu Luning;Wang Yuxi;Yang Ting;Yao Hui(School of Nursing,Beijing University of Chinese Medicine,Beijing 100029,China)
出处
《北京医学》
2025年第9期783-793,共11页
Beijing Medical Journal
关键词
卒中
肠内营养
喂养不耐受
胃残余量
影响因素
META分析
循证护理
stroke
enteral nutrition(EN)
feeding intolerance
gastric residual volume(GRV)
influencing factor
meta-analysis
evidence-based nursing
