肺移植术后肠内营养患者喂养不耐受的现状及影响因素分析

doi:10.3761/j.issn.0254-1769.2025.07.013

摘要/Abstract

摘要：

目的调查肺移植术后肠内营养患者喂养不耐受的发生现状，并分析其影响因素，为制订合理的肠内营养方案，改善患者的营养状况提供参考。方法采用便利抽样法，回顾性收集2022年8月—2023年11月在广东省某三级甲等医院ICU住院的115例肺移植术后、接受肠内营养支持患者的临床资料，根据患者是否发生喂养不耐受，将其分成喂养耐受组和喂养不耐受组，采用单因素分析、Logistic回归分析筛选肺移植术后肠内营养患者喂养不耐受的影响因素。结果在启动肠内营养7 d内，有63例患者发生喂养不耐受，发生率为54.78%。其中，启动肠内喂养后1~3 d喂养不耐受的发生率较高。喂养不耐受的临床表现包括腹泻、腹胀、胃潴留、呕吐或反流，其中腹泻的发生率最高，为87.30%。Logistic回归分析结果显示，术中液体净平衡量（OR=0.999）、术中输血量（OR=1.001）和糖尿病史（OR=0.170）是肺移植术后肠内营养患者喂养不耐受的独立影响因素（P<0.05）。结论肺移植术后肠内营养患者喂养不耐受的发生率较高，术中液体净平衡量多、术中输血量少和有糖尿病史的肺移植术后肠内营养患者发生喂养不耐受的风险较低。医护人员在启动肠内营养时，应动态评估喂养不耐受的危险因素，尽早筛查高危患者，制订合理的肠内营养方案，以改善患者的营养状况，促进其康复。

关键词: 肺移植, 肠内营养, 喂养不耐受, 影响因素分析, 护理

Abstract:

Objective To investigate the status of feeding intolerance in patients with enteral nutrition after lung transplantation and analyze its influencing factors，to provide a reference for formulating a reasonable enteral nutrition plan and improving patients’ nutritional status. Methods Convenient sampling method was used to retrospectively collect the clinical data of 115 patients who received enteral nutrition support after lung transplantation and were hospitalized in the ICU of a tertiary hospital in Guangdong Province from August 2022 to November 2023. According to the occurrence of feeding intolerance during ICU hospitalization，the patients were divided into a feeding tolerance group and a feeding intolerance group. Univariate and logistic regression analysis were used to analyze the influencing factors of feeding intolerance patients with enteral nutrition after lung transplantation. Results Within 7 days of initiating enteral nutrition，a total of 63 patients developed feeding intolerance，with an incidence of 54.78%. Among them，the incidence of feeding intolerance was relatively high within 1 to 3 days after initiating enteral feeding. The clinical manifestations of feeding intolerance were diarrhea，bloating，gastric retention，vomiting/regurgitation，among which the diarrhea was the highest incidence（87.30%）. Logi-stic regression analysis showed that intraoperative net balance volume（OR=0.999），intraoperative blood transfusion（OR=1.001） volume and diabetes history（OR=0.170） were independent influencing factors for feeding intolerance in patients with enteral nutrition after lung transplantation（P<0.05）. Conclusion There was a high incidence of feed-ing intolerance in patients with enteral nutrition after lung transplantation. Patients undergoing lung transplantation who have a high net intraoperative fluid balance，receive a low volume of intraoperative blood transfusions，and have a history of diabetes are at a lower risk of developing feeding intolerance when receiving postoperative enteral nutrition. When starting enteral nutrition，medical staff should dynamically evaluate the risk factors of feeding intolerance，screen high-risk patients as early as possible，and formulate reasonable enteral nutrition programs to improve the nutritional status of patients and promote their rehabilitation.

Key words: Lung Transplantation, Enteral Nutrition, Feeding Intolerance, Root Cause Analysis, Nursing Care

陈丽花, 黄瑶, 盛青青, 谭玉凤, 张书琴, 黄小群, 徐蒙蒙. 肺移植术后肠内营养患者喂养不耐受的现状及影响因素分析[J]. 中华护理杂志, 2025, 60(7): 849-855.

CHEN Lihua, HUANG Yao, SHENG Qingqing, TAN Yufeng, ZHANG Shuqin, HUANG Xiaoqun, XU Mengmeng. Status and influencing factors of feeding intolerance in patients with enteral nutrition after lung transplantation[J]. Chinese Journal of Nursing, 2025, 60(7): 849-855.

图/表 3

表1 肺移植术后肠内营养患者的一般资料及喂养不耐受影响因素的单因素分析结果

Table 1 The general information of enteral nutrition in patients after lung transplantation and the results of single factor analysis regarding influencing factors associated with enteral feeding intolerance

表2 自变量赋值方式

Table 2 Independent variable assignment

表3 肺移植术后肠内营养患者喂养不耐受影响因素的Logistic回归分析结果（n=115）

Table 3 Logistic regression analysis of influencing factors of feeding intolerance in patients with enteral nutrition after lung transplantation（n=115）

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