持续肠内营养患者胃残余量变化趋势及喂养达标的影响因素研究

doi:10.3761/j.issn.0254-1769.2021.01.008

摘要/Abstract

摘要：

目的探讨ICU持续肠内营养患者的胃残余量变化趋势,比较不同胃残余量患者喂养达标情况,并进一步分析喂养达标率的影响因素。方法选取2014年1月—2019年8月入住北京市某三级甲等医院内科ICU病房且经鼻持续肠内营养的患者作为研究对象,对其住院7 d的病历资料进行回顾性分析,描述研究对象在ICU住院7 d内胃残余量的变化趋势,比较ICU住院第7天不同胃残余量患者喂养达标情况,采用Logistic回归分析喂养达标的影响因素。结果共纳入1 057例ICU持续肠内营养的患者,住院7 d内胃残余量高峰时段为开始喂养后第8小时或第12小时;纳入715例ICU住院日≥7 d的患者,第7天喂养达标率为23.1%,胃残余量>200 ml的患者喂养达标率显著低于胃残余量<200 ml的患者（14.1%,24.3%,χ²=4.023,P=0.045）;超重（OR=0.490,P=0.003）和肥胖（OR=0.347,P=0.022）、序贯器官衰竭评分（OR=0.930,P=0.024）为喂养达标的独立危险因素,偏瘦（OR=2.464,P=0.007）、机械通气（OR=2.116,P=0.004）是喂养达标的保护性因素。结论 ICU患者的胃残余量变化存在规律性改变,较多患者存在摄入营养不足的情况,但胃残余量>200 ml并非喂养达标的独立影响因素,临床医护人员要更多关注超重、肥胖及序贯器官衰竭评分较高的ICU患者摄入营养情况。

关键词: 重症监护病房, 营养支持, 肠道营养, 胃残余量, 影响因素, 护理

Abstract:

Objective To explore the variation trend of gastric residual volume and influencing factors of full feeding in ICU patients receiving continuous enteral nutrition. Methods Patients admitted in medical ICU of Peking Union Medical College Hospital from January 2014 to August 2019 were enrolled,and a retrospective analysis of patients receiving continuous enteral feeding via nasogastric tube was performed. The variation trend of gastric residual volume during the first 7 ICU days was analyzed;the full feeding rates of the 7th day between different groups with gastric residual volume more or less than 200 ml were compared;influencing factors of full feeding were evaluated by univariate analysis and multivariate logistic regression analysis. Results 1 057 ICU patients were enrolled,and the peak of gastric residual volume during the first 7 ICU days occurred at the 8th to 12th hour after the beginning of continuous enteral feeding. 715 patients who stayed in ICU over 7 days were analyzed for full feeding;23.1% of patients reached full feeding target on the 7th day;the full feeding rates of patients with gastric residual volume larger than 200ml（14.1%） were significantly lower than those of patients with less gastric residual volume（24.3%, χ²=4.023,P=0.045）. Overweight（OR=0.490,P=0.003）,obesity（OR=0.347,P=0.022）,and SOFA score（OR=0.930,P=0.024）were independent risk factors of full feeding,while underweight（OR=2.464,P=0.007,） and mechanical ventilation（OR=2.116,P=0.004）were protective factors. Conclusion The gastric residual volume of ICU patients receiving continuous enteral feeding varies regularly,and many patients have not been fully fed,while large gastric residual volume is not an independent risk factor of full feeding. Therefore,patients who are overweight,obese or have greater SOFA score should receive much attention on their enteral feeding.

Key words: Intensive Care Units, Nutritional Support, Enteral Nutrition, Gastric Residual Volume, Influencing Factors, Nursing Care

余昆容,夏莹,赵淑雅,李峥,翁利. 持续肠内营养患者胃残余量变化趋势及喂养达标的影响因素研究[J]. 中华护理杂志, 2021, 56(1): 50-55.

YU Kunrong,XIA Ying,ZHAO Shuya,LI Zheng,WENG Li. Variation trend of gastric residual volume and influencing factors of full feeding in patients receiving continuous enteral nutrition[J]. Chinese Journal of Nursing, 2021, 56(1): 50-55.

图/表 5

图1 ICU住院前3d胃残余量变化趋势图

Fig 1 Variation trend of gastric residual volume during first 3 ICU days

图2 ICU住院第4天至第7天胃残余量变化趋势图

Fig 2 Variation trend of gastric residual volume between the 4th and 7thICU day

表1 患者一般资料对胃残余量影响的比较

Tab.1 Characteristics of the patients and full feeding rate in two groups

表2 ICU住院第7天喂养达标单因素分析结果

Univariate analysis of factors associated with full feeding in patients on the 7thICU

表3 ICU住院第7天喂养达标多因素Logistic回归分析结果

Multivariate analysis of factors associated with full feeding in patients on the 7th ICU day

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