神经外科肠内营养患者腹内压变化轨迹的潜在类别及影响因素研究

doi:10.3761/j.issn.0254-1769.2026.07.009

摘要/Abstract

摘要：

目的探究神经外科肠内营养患者腹内压变化轨迹的潜在类别及其影响因素，为识别腹内高压高风险患者提供参考。方法按入院顺序选取2024年1月—2025年6月在武汉市某三级甲等综合医院神经外科重症监护室住院且接受肠内营养支持的137例患者作为调查对象，收集其社会人口学及疾病相关资料，并在肠内营养第1~7天测量其腹内压。采用潜变量增长混合模型识别患者腹内压变化轨迹的潜在类别，使用Logistic回归分析探究其影响因素。结果脱落9例患者，最终纳入128例，其腹内压变化轨迹分为3个潜在类别，包括早期高压-后期缓解型（13.28%）、早期正常-中期高压-后期缓解型（17.19%）和持续正常型（69.53%）。Logistic回归分析结果显示，BMI、是否进行机械通气、是否使用镇静药物、喂养途径、有无腹胀、血清白蛋白浓度以及是否接受亚低温治疗是神经外科肠内营养患者腹内压变化轨迹潜在类别的影响因素（均P<0.05）。结论神经外科肠内营养患者腹内压变化轨迹存在3个潜在类别。医护人员应重点关注BMI较高、进行机械通气、经鼻胃管喂养、使用镇静药物、腹胀以及血清白蛋白浓度较低的患者，加强其腹内压监测，并制订个性化的营养管理方案。

关键词: 神经系统疾病, 肠内营养, 腹内压, 潜在类别分析, 影响因素分析, 危重病护理

Abstract:

Objective To identify the latent trajectories of intra-abdominal pressure（IAP） in neurosurgery critically ill patients receiving enteral nutrition and to analyze their influencing factors，aiming to provide a reference for the early identification of populations at high risk for intra-abdominal hypertension. Methods A total of 137 patients admitted to the neurosurgical intensive care unit of a tertiary grade-A general hospital in Wuhan from January 2024 to June 2025 were enrolled. Clinical and socio-demographic data，along with daily IAP values from day 1 to day 7 of enteral nutrition，were collected. Growth mixture model（GMM） was utilized to identify distinct IAP trajectories，and multivariate logistic regression was performed to determine independent predictors. Results Ultimately，128 patients were included，with 9 patients dropping out. 3 heterogeneous trajectories were identified，inlcuding early hypertension with late remission type（13.28%），early normal-midterm high pressure-later alleviation type（17.19%），and persistent normalcy type（69.53%）. BMI，mechanical ventilation，sedative use，feeding route，abdominal distension，serum albumin，and mild hypothermia therapy were significantly associated with the trajectory of intra-abdominal pressure（P<0.05）. Conclusion IAP changes in neurosurgery patients under enteral nutrition exhibit significant inter-individual heterogeneity across 3 latent patterns. Medical staff should prioritize high-risk patients，specifically those with elevated BMI，mechanical ventilation，nasogastric feeding，sedative use，abdominal distension，and hypoproteinemia，to implement targeted IAP monitoring and individualized nutrition management.

Key words: Nervous System Diseases, Enteral Nutrition, Intraabdominal Pressure, Potential Category Analysis, Root Cause Analysis, Critical Care Nursing

张晴, 赵恺, 厉春林, 胡娜, 陆小燕. 神经外科肠内营养患者腹内压变化轨迹的潜在类别及影响因素研究[J]. 中华护理杂志, 2026, 61(7): 924-931.

ZHANG Qing, ZHAO Kai, LI Chunlin, HU Na, LU Xiaoyan. Study on the potential categories and influencing factors of intra-abdominal pressure change trajectory in critically ill patients with enteral nutrition in neurosurgery[J]. Chinese Journal of Nursing, 2026, 61(7): 924-931.

图/表 5

表1 调查对象的一般资料及腹内压变化轨迹潜在类别的单因素分析结果

Table 1 General information of the respondents and the results of univariate analysis on latent classes of intra-abdominal pressure change trajectories

表2 神经外科肠内营养患者腹内压变化轨迹的潜变量增长混合模型拟合结果

Table 2 Mixed model fitting results of latent variable growth of intra-abdominal pressure change trajectory in critically ill patients with enteral nutrition in neurosurgery departments

表3 神经外科肠内营养患者不同潜在类别的腹内压变化情况（mmHg，$\bar{x}±s$）

Table 3 The changes of intra-abdominal pressure in different potential categories of critically ill patients with enteral nutrition in neurosurgery departments（mmHg，$\bar{x}±s$）

图1 神经外科肠内营养患者不同潜在类别的腹内压变化轨迹

Figure 1 The change trajectory of intra-abdominal pressure in different potential categories of critically ill patients with enteral nutrition in neurosurgery departments

表4 神经外科肠内营养患者腹内压变化轨迹潜在类别的Logistic回归分析结果

Table 4 Multivariate Logistic regression analysis of latent classes of intra-abdominal pressure trajectory in neurosurgical critically ill patients with enteral nutrition

参考文献 23

[1]	Jaan A, Sarfraz Z, Farooq U, et al. Incidence,implications and predictors of abdominal compartment syndrome in acute pancreatitis:a nationwide analysis[J]. Pancreatology, 2024, 24(3):370-377. DOI PMID
[2]	张晴, 厉春林, 赵恺, 等. 神经外科重症病人肠内营养并发腹压增高的危险因素[J]. 中国临床神经外科杂志, 2024, 29(6):350-354.
	Zhang Q, Li CL, Zhao K, et al. Risk factors for intra-abdominal hypertension in critically ill neurosurgical patients after ente-ral nutrition[J]. Chin J Clin Neurosurg, 2024, 29(6):350-354.
[3]	袁梦湄, 唐佳迎, 黄晓霞, 等. 腹内压监测在腹腔高压患者肠内营养中的应用进展[J]. 中华护理杂志, 2022, 57(19):2353-2357. DOI URL
	Yuan MM, Tang JY, Huang XX, et al. Research progress on the application of intra-abdominal pressure monitoring in enteral nutrition for patients with abdominal hypertension[J]. Chin J Nurs, 2022, 57(19):2353-2357. DOI URL
[4]	于涵静. 增长混合模型:聚焦群体异质性特征[J]. 外语学刊, 2025(2):19-26.
	Yu HJ. Growth mixture modeling:focusing on the heterogeneity[J]. Foreign Lang Res, 2025(2):19-26.
[5]	中华医学会神经外科学分会,中国神经外科重症管理协作组. 中国神经外科重症管理专家共识(2020版)[J]. 中华医学杂志, 2020, 100(19):1443-1458.
	Chinese Society of Neurosurgery,Chinese Medical Association,China Neurosurgical Critical Care Management Collaborative Group. Expert consensus on neurosurgical critical care management in China(2020 edition)[J]. Med J China, 2020, 100(19):1443-1458.
[6]	中华医学会神经外科分会,中国神经外科重症管理协作组. 中国神经外科重症患者营养治疗专家共识(2022版)[J]. 中华医学杂志, 2022, 102(29):2236-2255.
	Chinese Society of Neurosurgery,Chinese Medical Association,China Neurosurgical Critical Care Management Collaborative Group. Expert consensus on nutritional therapy for critically ill patients in neurosurgery in China(2022 edition)[J]. Natl Med J China, 2022, 102(29):2236-2255.
[7]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation hi quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[8]	王梅梅, 王银娥, 乔安花, 等. ICU患者基于腹内压分级肠内营养管理的最佳证据总结[J]. 现代临床护理, 2025, 24(1):68-76.
	Wang MM, Wang YE, Qiao AH, et al. Graded enteral nutrition management based on intra-abdominal pressure for ICU patients:a summary of best evidence[J]. Mod Clin Nurs, 2025, 24(1):68-76.
[9]	李志茹, 卢芳燕, 吉莉, 等. 护士主导的肝移植患儿腹内压管理方案的构建及应用研究[J]. 中华护理杂志, 2024, 59(19):2319-2325. DOI URL
	Li ZR, Lu FY, Ji L, et al. Construction and application of a nurse-led intra-abdominal pressure management program in children undergoing liver transplantation[J]. Chin J Nurs, 2024, 59(19):2319-2325. DOI URL
[10]	中国腹腔重症协作组. 重症患者腹内高压监测与管理专家共识(2020版)[J]. 中华消化外科杂志, 2020, 19(10):1030-1037.
	China Abdominal Critical Care Collaborative Group. Expert consensus on monitoring and management of intra-abdominal hypertension in severe patients(2020 edition)[J]. Chin J Dig Surg, 2020, 19(10):1030-1037.
[11]	米元元, 向成林, 吴边, 等. 重症患者肠内营养相关性腹胀的研究进展[J]. 护理学杂志, 2025, 40(9):121-125.
	Mi YY, Xiang CL, Wu B, et al. Research progress on enteral nutrition-associated abdominal distension in critically ill patients[J]. J Nurs Sci, 2025, 40(9):121-125.
[12]	蒋丽, 陆佩娟, 王洪干, 等. 脑出血患者肠内营养并发腹内压增高风险预测模型构建[J]. 当代医药论丛, 2025, 23(30):1-4.
	Jiang L, Lu PJ, Wang HG, et al. Construction of risk prediction model of enteral nutrition complicated with increased intra-abdominal pressure in patients with cerebral hemorrhage[J]. Contemp Med Symp, 2025, 23(30):1-4.
[13]	Zheng R, Jiang YX, Yan C, et al. Intra-abdominal hypertension contributes to the development of ventilator-associated pneumonia from intestinal bacteria[J]. Infect Drug Resist, 2023, 16:1913-1921. DOI PMID
[14]	Mohan S, Lim ZY, Chan KS, et al. Impact of obesity on clinical outcomes of patients with intra-abdominal hypertension and abdominal compartment syndrome[J]. Life, 2023, 13(2):330. DOI URL
[15]	王敏, 张艳, 仲爱玲, 等. 不同体位变化对机械通气患者膀胱压测量值的影响[J]. 当代护士(下旬刊), 2022, 29(3):105-107.
	Wang M, Zhang Y, Zhong AL, et al. Effect of different body position changes on bladder pressure measurement in patients with mechanical ventilation[J]. Mod Nurse, 2022, 29(3):105-107.
[16]	盛晓峰, 张奕, 李咏臻, 等. 不同腹内压水平对呼吸力学影响的研究[J]. 生物医学工程与临床, 2024, 28(4):578-583.
	Sheng XF, Zhang Y, Li YZ, et al. Study on the effect of different intra-abdominal pressure levels on respiratory mechanics parameters[J]. Biomed Eng Clin Med, 2024, 28(4):578-583.
[17]	程乐平, 鲁厚清. 脑电双频指数监测下镇静联合亚低温治疗在颅脑术后重症患者的临床应用[J]. 川北医学院学报, 2021, 36(2):242-245.
	Cheng LP, Lu HQ. Clinical application of sedation under bispectral index monitoring combined with mild hypothermia in severe patients after craniotomy[J]. J N Sichuan Med Coll, 2021, 36(2):242-245.
[18]	朱满意, 韦正祥, 李明新. 床旁超声评估右美托咪定镇静对机械通气患者胃肠功能的影响[J]. 临床急诊杂志, 2021, 22(5):309-313.
	Zhu MY, Wei ZX, Li MX. Effect of dexmedetomidine sedation on gastrointestinal function in patients with mechanical ventilation by bedside ultrasound[J]. J Clin Emerg, 2021, 22(5):309-313.
[19]	解利平, 苏龙, 李强, 等. 鼻肠管与鼻胃管在重型创伤性脑损伤病人肠内营养安全性比较的Meta分析[J]. 中国微侵袭神经外科杂志, 2024, 28(2):94-101.
	Xie LP, Su L, Li Q, et al. Meta-analysis of the comparison in safety between nasojejunal tube and nasogastric tube for enteral nutrition in patients with severe traumatic brain injury[J]. Chin J Minim Invasive Neurosurg, 2024, 28(2):94-101.
[20]	曾喜云. 留置鼻肠管与鼻胃管行肠内营养干预对重型颅脑损伤患者营养状态并发症及预后的影响对比[J]. 基层医学论坛, 2023, 27(27):19-22.
	Zeng XY. Effects of naso-intestinal tube indwelling and nasogastric tube indwelling for enteral nutrition intervention on nutritional status,complications and prognosis of severe craniocerebral injury[J]. Med Forum, 2023, 27(27):19-22.
[21]	毛鸿晓, 蒋和娣, 李有政, 等. 水解乳清蛋白在脑出血术后合并低蛋白血症病人肠内营养管理中的应用[J]. 护理研究, 2022, 36(5):938-940.
	Mao HX, Jiang HD, Li YZ, et al. Application of hydrolyzed whey protein in enteral nutrition management of patients with hypoproteinemia after intracerebral hemorrhage[J]. Chin Nurs Res, 2022, 36(5):938-940.
[22]	封秀琴, 蔡凌云, 周佳佳, 等. 15例特重度烧伤俯卧位通气患者早期幽门后喂养不减速的护理[J]. 中华护理杂志, 2021, 56(5):748-750. DOI URL
	Feng XQ, Cai LY, Zhou JJ, et al. Nursing care of non-slow down post-pyloric feeding for 15 severe burn patients with prone ventilation[J]. Chin J Nurs, 2021, 56(5):748-750. DOI URL
[23]	袁梦湄, 黄晓霞, 唐佳迎, 等. 以腹内压监测为导向的腹腔高压患者肠内营养护理方案的构建及应用[J]. 中华护理杂志, 2023, 58(12):1413-1421. DOI URL
	Yuan MM, Huang XX, Tang JY, et al. Construction and application of enteral nutrition protocol for patients with intra-abdominal hypertension oriented by intra-abdominal pressure[J]. Chin J Nurs, 2023, 58(12):1413-1421. DOI URL