文章摘要
重症急性胰腺炎肠内营养喂养不耐受的影响因素分析及腹内压的预测价值探讨
Analysis of Influencing Factors of Enteral Nnutrition Feeding Intolerance in Severe Acute Pancreatitis and Explore the Predictive Value of Intra-Abdominal Pressure
投稿时间:2022-04-06  修订日期:2022-04-06
DOI:
中文关键词: 重症急性胰腺炎  肠内营养  喂养不耐受  腹内压
英文关键词: Severe acute pancreatitis  Enteral nutrition  Feeding intolerance  Intra-abdominal pressure
基金项目:江苏省自然科学基金项目(BK201506415)
作者单位邮编
赵珊珊 江苏省人民医院 210000
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中文摘要:
      目的 分析重症急性胰腺炎(SAP)患者肠内营养喂养不耐受的影响因素,并探讨腹内压对其的预测价值。方法 选取2018年1月~2021年1月江苏省人民医院ICU收治的80例SAP患者,均经三腔鼻空肠管实施肠内营养治疗,统计肠内营养不耐受发生情况。收集所有患者的临床资料,多因素Logistic回归分析SAP患者肠内营养喂养不耐受的影响因素,受试者工作特征(ROC)曲线分析腹内压对SAP患者肠内营养喂养不耐受的预测价值。结果 80例SAP患者肠内营养喂养不耐受发生率为53.75%(43/80)。多因素Logistic回归分析结果显示,年龄≥60岁(OR=4.679,95%CI:1.549~23.078,P=0.026)、肠内营养开始时间≥72h(OR=7.069,95%CI:1.700~29.395,P=0.007)、腹内压≥15mmHg(OR=4.495,95%CI:1.137~17.770,P=0.032)为SAP患者肠内营养喂养不耐受的危险因素,而白蛋白≥35g/L(OR=0.264,95%CI:0.073~0.956,P=0.042)、添加膳食纤维(OR=0.178,95%CI:0.048~0.662,P=0.010)是SAP患者肠内营养喂养不耐受的保护因素。ROC曲线分析结果显示,腹内压预测SAP患者肠内营养喂养不耐受的曲线下面积为0.809(95%CI:0.706~0.888),敏感性为79.07%,特异性为72.97%。结论 SAP患者肠内营养喂养不耐受与年龄、肠内营养开始时间、腹内压、白蛋白水平、是否添加膳食纤维有关,腹内压对SAP患者肠内营养喂养不耐受具有一定预测价值。
英文摘要:
      Objective:To analyze the influencing factors of enteral nutrition feeding intolerance in patients with severe acute pancreatitis (SAP), and to explore the predictive value of intra-abdominal pressure on it. Methods:80 patients with SAP who were treated in the ICU of Jiangsu Provincial People''s Hospital from January 2018 to January 2021 were selected, and they were treated with enteral nutrition through three lumen nasojejunal tube, and the incidence of enteral nutrition intolerance was counted. The clinical data of all patients were collected, the influencing factors of enteral nutrition feeding intolerance in patients with SAP were analyzed by multivariate Logistic regression, and the predictive value of intra-abdominal pressure on enteral nutrition feeding intolerance in patients with SAP was analyzed by receiver operating characteristic (ROC) curve. Results:The incidence of enteral nutrition feeding intolerance in 80 patients with SAP was 53.75% (43 / 80). Multivariate Logistic regression analysis showed that age ≥ 60 years (OR= 4.679, 95% CI: 1.549 ~ 23.078, P = 0.026), the start time of enteral nutrition ≥ 72h (OR= 7.069, 95% CI: 1.700 ~ 29.395, P = 0.007), and intra-abdominal pressure ≥ 15 mmHg (OR= 4.495, 95% CI: 1.137 ~ 17.770, P = 0.032) were the risk factors of enteral nutrition feeding intolerance in patients with SAP, while albumin ≥ 35g / L (OR= 0.264, 95% CI: 0.073 ~ 0.956, P = 0.042) and added dietary fiber were (OR= 0.178, 95% CI: 0.048 ~ 0.662, P = 0.010) were the protective factor of enteral nutrition feeding intolerance in patients with SAP. The ROC curve analysis showed that the area under the curve of intra-abdominal pressure predicting enteral nutrition feeding intolerance in patients with SAP was 0.809 (95% CI: 0.706 ~ 0.888), the sensitivity was 79.07%, and the specificity was 72.97%. Conclusion:Enteral nutrition feeding intolerance in patients with SAP is related to age, start time of enteral nutrition, intra-abdominal pressure, albumin level and whether to add dietary fiber. Intra-abdominal pressure has a certain predictive value for enteral nutrition feeding intolerance in patients with SAP.
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