Abstract:

Objective To understand the current situation of aspiration in ICU patients with different feeding patterns and to compare its characteristics,so as to provide a basis for targeted prevention of aspiration. Methods The study was a prospective study. The convenience sampling method was used to select patients who were admitted to the ICU of a tertiary hospital in Suzhou from January 2020 to April 2021 as the survey subjects. According to the different feeding patterns,patients were divided into an oral feeding group,a gastric tube feeding group and a post-pyloric feeding group. The occurrence and characteristics of dominant aspiration and micro-aspiration of patients with different feeding patterns were observed and compared. Results A total of 721 patients were enrolled. The incidences of dominant aspiration in the oral feeding group,the gastric tube feeding group and the post-pyloric feeding group were 8.10%,15.26%,and 11.26%. The incidences of micro-aspiration were 76.95%,77.11%,and 58.28%,respectively. The characteristics of the occurrence of dominant aspiration in 3 groups were compared. The time of first aspiration in the gastric feeding group earlier than that in the post-pyloric feeding group;the oral feeding group had the most frequent aspirations. The proportions of patients with impaired consciousness,gastric retention,intra-abdominal hypertension,dysphagia,and mechanical ventilation in the gastric feeding group and the post-pyloric feeding group were higher than that in the oral feeding group（Bonferroni method,all P<0.017）. The characteristics of micro-aspiration among 3 groups were compared;the proportion of patients with vomiting in the oral feeding group was higher than that in the post-pyloric feeding group;the acute physiology and chronic health scores and ICU stay time of the patients in the post-pyloric feeding group were higher than those in the oral feeding group;the proportions of patients with impaired consciousness and mechanical ventilation in the gastric tube feeding group and the post-pyloric feeding group were higher than that in the oral feeding group. The above differences are statistically significant（Bonferroni method,all P<0.017）. Conclusion The incidence of dominant aspiration and micro-aspiration in ICU patients fed by gastric tube was higher, and the characteristics of aspiration in ICU patients with different feeding patterns were significantly different. Clinically,individualized preventive measures should be taken as early as possible according to the characteristics of the patient and the way of eating.

Key words: Critical Illness, Intensive Care Units, Aspiration, Eating, Enteral Nutrition, Disease Characteristics, Nursing Care

摘要：

目的 了解不同进食方式的ICU患者显性误吸和微误吸的发生现状,并比较其特征,为针对性开展误吸预防提供依据。方法 该研究为前瞻性研究,采用便利抽样法,选取2020年1月—2021年4月入住苏州市某三级甲等医院ICU的患者作为调查对象,根据患者进食方式分为经口进食组、经胃管喂养组及经幽门后喂养组,观察并比较不同进食方式患者显性误吸及微误吸的发生情况及特征。 结果 共纳入721例患者。经口进食组、经胃管喂养组及经幽门后喂养组显性误吸发生率分别为8.10%、15.26%、11.26%;微误吸发生率分别为76.95%、77.11%、58.28%。3组显性误吸发生特征比较,经胃管喂养组首次误吸发生时间早于经幽门后喂养组;经口进食组显性误吸发生次数多于经胃管喂养组和经幽门后喂养组;经胃管喂养组和经幽门后喂养组意识障碍、胃潴留、腹内高压、吞咽障碍、机械通气患者的比例高于经口进食组,差异均具有统计学意义（Bonferroni法,均P<0.017）。3组微误吸发生特征比较,经口进食组呕吐患者的比例高于经幽门后喂养组;经幽门后喂养组急性生理与慢性健康状况评分高于经口进食组、入住ICU时间长于经口进食组;经胃管喂养组和经幽门后喂养组意识障碍、机械通气患者的比例高于经口进食组,差异均具有统计学意义（Bonferroni法,均P<0.017）。结论 经胃管喂养的ICU患者显性误吸、微误吸的发生率较高,不同进食方式的ICU患者误吸发生特征有明显差异。临床护士应根据患者的特征、进食方式,及早采取个性化的预防措施。

关键词: 危重病, 重症监护病房, 误吸, 进食, 肠道营养, 疾病特征, 护理