危重患者肠内营养期间腹泻原因探讨

目的探讨危重症患者肠内营养治疗期间发生腹泻的相关因素及预防对策。方法调查我院2012年期间进行肠内营养治疗的危重症成年患者240例,收集其临床资料,并按是否发生腹泻分为腹泻组和对照组,分析两组之间相关因素差异。结果腹泻组69例,对照组171例,共筛选出APACHEⅡ评分〉15分、禁食时间≥7d、血清白蛋白〈28g/L、抗生素使用时间〉14d、使用促胃肠动力药等5个因素为肠内营养患者腹泻的危险因素（P〈0.05）,及使用益生菌等1个因素为肠内营养患者腹泻的保护因素（P〈0.05）。结论患者APACHEⅡ评分〉15分、禁食时间≥7d、血清白蛋白低〈28g/L、抗生素使用时间〉14d及使用促胃肠动力药可以导致肠内营养期间腹泻率增加,而给予患者微生物制剂可减少腹泻的发生。

Investigate of Diarrhea Cause in Critically Ill Patients During Enteral Nutrition

Objective To analyze the factors related to diarrhea in critically ill patients during enteral nutrition（EN）and preventive countermeasures.Methods The clinical data of 240 critically ill patients during EN in our hospital in 2012 were retrospectively studied.All the cases were divided into diarrhea group and control group.The clinical data was analyzed retrospectively.Results In diarrhea group of 118 cases and control group of 132 cases,it showed that the high APACHE II score（15）,the long fasting time before EN（≥7d）,low plasma albumin level（〈28g/L）,long-time antibiotics usage（〉14d）,usage of gastrointestinal dynamical medicine were risk factors for diarrhea（P〈0.05）,while,using probiotics preparation was protective factor for diarrhea（P〈0.05）.Conclusion The important risk factors of higher APACHE II score,longer fasting time before EN,lower plasma album level,long-time antibiotics usage may increase the incidence of diarrhea,while,using probiotics preparation may reduce the incidence of diarrhea.