机械通气患者行肠内营养发生反流的危险因素

目的 研究机械通气患者行肠内营养发生反流的危险因素.方法 对海军总医院ICU连续收治的行肠内营养的机械通气患者的反流情况进行分析.记录患者的一般情况以及患者的体位、置管位置、喂养方式、是否气管切开、药物干预等因素,对上述资料进行单因素分析,选择有意义的变量(P<0.05)进行多因素非条件Logistic回归分析.结果 2009年1月至2010年12月共入选满足纳入标准的患者79例,年龄(58.6±15.3)岁;其中男44例,女35例;APACHE Ⅱ评分18.1±4.0.单因素分析结果 显示年龄、体位、置管位置、喂养方式、是否气管切开等均与反流的发生有关.Logistic回归分析显示年龄>60岁(OR=4.577,95%CI:1.459～14.363,P=0.009)是机械通气患者行肠内营养发生反流的独立危险因素,而半卧位>30°(OR=0.201,95%CI:0.057～0.708,P=0.013)、留置鼻肠管(OR=0.267,95%CI:0.072～0.993,P=0.049)、气管切开(OR=0.232,95%CI:0.070～0.763,P=0.016)是机械通气患者行肠内营养发生反流的独立保护因素.结论 年龄>60岁的患者发生反流的概率较高,而半卧位>30°、留置鼻肠管、气管切开的患者发生反流物误吸的概率较低.

Abstract：

Objective To study the risk factors for the reflux of enteral nutrition in the mechanical ventilated ( MV) patients. Methods The data of reflux in 79 MV patients fed by enteral nutrition were collected. These patients were consecutively admitted to intensive care unit (ICU) of the Navy General Hospital from Jan. 2009 to Dec. 2010. Patients' performance conditions,patients' body position,location of feeding tube, way of feeding,tracheotomy,drug intervention were recorded. Simple logistic regression was used to analyze all the risk factors, and statistically significant variables were selected and adopted in multivariate and unconditioned Logistic regression analysis. Results The subjects averagely aged (58.6 ± 15. 3)years old,including 44 males and 35 females;with an APACHE Ⅱ score of 18. 1 ±4.0. Univariate analysis showed that age,position,location of feeding tube,way of feeding, tracheotomy et al were all assoctied with reflux. Advanced age( >60 y) ( OR = 4.577,95% CI 1. 459 - 14. 363, P =0. 009) was an independent risk factor for reflux; semisupination at 30° (OR =0.201,95%CI 0.057 -0.708,P = 0.013),nasalenteral tube (OR =0.267,95% CI0.072 -0.993,P = 0.049) ,and tracheotomy (OR = 0.232,95%CI0.070 -0.763,P =0.016) were independent protecting factors for the reflux. Conclusion Advanced age ( > 60 y) is a high risk factor for the MV patients with enteral nutrition;, semisupination at 30° .nasalenteral feeding,tracheotomy are low risk factors for the MV patients with enteral nutrition.     

鼻空肠管在重度COPD患者营养支持治疗中的应用研究

目的 探讨重度慢性阻塞性肺疾病(COPD)患者应用鼻空肠管行肠内营养(EN)支持疗法的临床应用价值.方法 选择住院Ⅲ、Ⅳ级COPD患者共96例.随机分为A(30例)、B(32例)、C(34例)三组.A组:常规治疗+鼻空肠管EN;B组:常规治疗+鼻胃管EN;C组:常规治疗+普通饮食.治疗20 d后,比较三组患者的营养指标、呼吸功能指标和死亡率的差异.结果 A、B、C三组患者在治疗后营养指标和呼吸功能指标均有显著改善,A组＞B组＞C组(P＜0.05或P＜0.01),A组死亡率低于B、C组(P＜0.01).结论 重度COPD患者应用鼻空肠管行肠内营养支持治疗,更有利于患者的康复,并明显降低其死亡率.

Abstract：

Objective To explore clinical application of nasojejunal tube for enteral nutrition (EN) support therapy on the severe chronic occlusion pulmonary disease (COPD) patients. Methods A total of 96 patients with Ⅲ, Ⅳ COPD were randomly divided into three groups: A (30 cases), B (32 cases), C (34 cases) . A group was received routine therapy and nasal jejunal tube EN; B group was re ceived routine therapy and nasogastric EN; C group was received routine therapy and normal diet. At 20 days after treatment, three groups of patients with nutritional indicators, respiratory function indicators and mortality differences were compared. Results After treatment, the nutrition indicators and respiratory function parameters of three groups were significantly improved (P ＜0. 05 or P ＜0. 01 ), and A group mortality rate was lower than B, C groups (P ＜ 0. 01 ) . Conclusions Severe COPD patients with nasal jejunal tube for enteral nutrition therapy will make for recovering, and the mortality rate is significantly reduced.     

鼻胃管肠内营养应用于重症患者的研究进展

临床营养支持根据营养供给途径分为肠外营养(paren-teral nutrition,PN)与肠内营养(enteral nutrition,EN)两种,是临床危重病治疗不可缺少的措施。肠内营养分口服和肠内管饲(enteral tube feeding,ETF)两种途径,后者包括鼻胃管、双腔胃-空肠管、鼻十二指肠管、鼻空肠管及各种造瘘管。随着人们对营养及供给途径的深入认识,营养支持已由PN为主的营养供给方式,转变为通过鼻胃管、鼻空肠管或胃(肠)造口途径的EN支持为主[1]。鼻胃管在临床管饲应用中最为普遍,一般经鼻插管,也可根据临床具体情况经口插入[2]。现将鼻胃管应用于重症患者肠内营…     

ICU危重患者肠内营养喂养不耐受护理干预评价

目的 分析综合护理干预方法对ICU危重患者肠内营养喂养不耐受的临床效果,探讨影响ICU危重患者肠内营养喂养不耐受的危险因素.方法 选取我院2010年6月至2013年4月38例ICU危重患者为研究对象,对其实施综合护理干预前后的肠内营养喂养耐受情况进行对比分析,同时对影响ICU危重患者肠内营养喂养不耐受的危险因素进行回归分析.结果 实施综合护理干预前后,年龄＜60岁的患者对肠内营养喂养的耐受性相比差异无统计学意义（P＞0.05）,而干预前后年龄≥60岁的患者对肠内营养喂养的耐受性相比差异有统计学意义（P＜0.05）.经过回归分析显示,患者年龄、肠内营养喂养开始时间、APACHE-Ⅱ评分、血清ALB及是否对患者进行药物鼻饲是影响ICU危重患者肠内营养喂养不耐受的高危因素.结论 介于ICU危重患者的年龄、肠内营养喂养开始时间、APACHE-Ⅱ评分、血清ALB及是否对患者进行药物鼻饲等客观因素对患者肠内营养喂养耐受性的重要影响,科学合理地综合护理干预对提高患者对肠内营养喂养的耐受性具有积极作用,值得临床予以推广.     

鼻肠管肠内营养应用于重型颅脑损伤患者的研究进展

临床营养支持途径分为肠外营养（parenteral nutrition,PN）与肠内营养（enteralnutrition,EN）两种。肠内营养分口服和管饲（enteral tube feeding,ETF）两种途径。随着临床实践证实,与肠外营养相比,肠内营养支持具有更多的优越性,营养支持已由PN为主的供给方式,转变为通过鼻胃管、鼻空肠管或胃（肠）造口途径的EN支持为主。     

重症脑卒中吞咽障碍26例疗效分析

INTRODUCTION Patients with severe cerebral hemorrhage and cerebral thrombus andserious dysphagia lived on nasal feeding and venous transfu-sion. These patients' quality of life, rehabilitation of paralysis,aphasia is unfavorable due to various complications. Therefore,many patients gave up treatment wearing nasal feeding tube. In thisstudy, we investigated treatment and affecting factors of dysphagia.     

危重患者早期肠内营养相关并发症分析

目的 观察综合性ICU危重症患者早期肠内营养支持中，相关并发症的发生及其相关因素。方法 119例入住ICU接受早期肠内营养支持患者，入ICU后根据24小时内各项监护指标及血常规、血气分析及肝肾功能检查，进行APACHE-Ⅱ评分。观察肠内营养量、速度、血清白蛋白(Alb)及肠内营养的耐受情况。总结各种肠内营养并发症的发生率。结果 随APACHE-Ⅱ评分的增加，肠内营养耐受的最大维持量降低、达最大维持量的时间延长、相关并发症的发生率增加。腹泻发生与Alb水平呈负相关，与APACHE-Ⅱ评分呈正相关。肠内营养并发症中以腹泻最为常见。结论 肠内营养相关并发症与疾病严重程度、血清蛋白水平等因素相关，一些危重患者无法过渡到完全肠内营养(TEN)，而需以静脉营养(PN) 肠内营养(EN)形式实现营养支持。     

带T管出院患者认知需求调查

目的 了解带T管出院患者对疾病的认知需求状况,以便采用更合理有效的干预措施满足患者的需求.方法 对留置T 管出院的36例患者发放自行设计的问卷调查表,以了解患者对疾病及健康的认知需求和为满足认知需求所需要的健康教育方式.结果 患者对T管需要留置的时间、如何进行自我观察及留置管道对正常工作及生活影响的认知需求最高,健康教育方式需求最高的为个体指导及发放根据认知需求调查制作的宣传手册.结论 在开展健康教育时,需考虑患者认知需求的特点,有针对性地开展健康教育,多种健康教育方式相结合,做到以人为本,促进患者早日康复.

Abstract：

Objective To investigate the situation of cognitive demands of the discharged patients with the T tube for disease status,in order to adopt a more rational and effective interventions to meet the needs of patients.Methods A total of 36 patients were assessed with the questionnaire survey designed to gauge patients' cognitive demand for disease and health education patterns. Results The patients' higher cognitive demands were T tube retention time, and how to make self-observation and effection of retention channels in normal work and life ,the higher demands for health education patterns were distributing brochure produced by based on a cognitive demand survey for the individual needs.Conclusions While carrying out health education need considering the characteristics of patients' cognitive demands ,target carrying out health education combined by multiple ways and so people-oriented and promoting the patients recovery.     

肠内营养治疗食管癌和贲门癌术后功能性胃排空障碍

目的 探讨肠内营养在功能性胃排空障碍治疗中的作用.方法 15例食管癌、贲门癌手术后功能性胃排空障碍患者,10例应用肠内营养,5例应用肠外营养,比较2组术后住院时间、胃肠减压 量、胃排空障碍恢复时间,评估肠内营养的疗效.结果 肠外营养组住院时间为(20.3±6.6)d,肠内营养组为(14.4±4.6)d;胃排空障碍恢复时间分别为(19±9)、(12±4)d.结论 肠内营养能促进胃肠道功能恢复,是治疗食管癌、贲门癌手术后功能性胃排空障碍的有效手段.

Abstract：

Objective To explore the role of enteral nutrition in the treatment of functional delayed gastric emptying. Methods Among 15 patients with functional delayed gastric emptying after resection of esophageal or gastric cardiac carcinoma, 10 patients were treated with enteral nutrition( EN group),5 patients were treated with parenteral nutrition (PN group). Postoperative hospital stay, gastrointestinal decompression amount, recovering time of postoperative gastric emptying were observed to assess the efficacy of enteral nutrition. Results The average postoperative hospital stay was ( 14. 4 ± 4. 6) days in the EN group, whereas (20. 3 ±6. 6) days in the PN group. The average recovering time of postoperative gastric emptying was (19 ±9)days in the PN group and( 12 ± 4)days in the EN group. Conclusion The method of EN can enhance gastric emptying and is effective for functional delayed gastric emptying after resection of esophageal or gastric cardiac carcinoma     

重症监护病房铜绿假单胞菌医院感染病例对照研究

目的 探讨重症监护病房(ICU)铜绿假单胞菌医院感染的危险因素,为制定医院感染的防治策略、措施提供依据.方法 采用回顾性病例对照研究和非条件Logistic多元回归分析方法,分析2002年1月至2006年12月1 950例ICU患者铜绿假单胞菌医院感染危险因素.结果 64例患者发生铜绿假单胞菌医院感染(作为感染组),发生率为3.3%.同期与感染组同一科室的37例发生大肠埃希菌医院感染患者作为对照组.单因素分析结果:使用激素、昏迷或颅脑损伤、腹部手术、有胸腹引流管、机械通气、开放气道是铜绿假单胞菌医院感染的危险因素[使用激素:相对比值比(OR)=3.364,95%可信区间(95%CI)1.445～7.830;昏迷或颅脑损伤:OR=4.026,95%CI 1.545～10.490;腹部手术,OR=0.166,95%CI 0.068～0.403;有胸腹引流管:OR=0.350,95%CI 0.150～0.818;开放气道:OR=4.095,95%CI 1.638～10.740].多因素Logistic分析结果:铜绿假单胞菌医院感染的独立危险因素有使用激素、机械通气(使用激素:OR=3.143,95%CI 1.115～8.856;机械通气:OR=3.195,95%CI 1.607～6.353,P＜0.05和P＜0.01).结论 使用激素和机械通气是铜绿假单胞菌医院感染的独立危险因素,应针对危险因素采取措施以控制医院感染.

Abstract：

Objective To investigate the risk factors of nosocomial infection caused by Pseudomonas aeruginosa in intensive care unit (ICU), in order to provide reference for an effective measure of infection control. Methods A retrospective study of cases of Pseudomonas aeruginosa infection occurring in ICU was made with multivariable Logistic regression analysis. The clinical data of 1 950 cases admitted from January 2002 to December 2006 were found to have nosocomial infection caused by Pseudomonas aeruginosa were analyzed in order to identify its independent risk factors. Results Sixty-four out of 1 950 patients were found to suffer from nosocomial infection caused by Pseudomonas aeruginosa, the morbidity rate was 3.3%. At the same time, and in the same department, 37 patients suffering from infection caused by Escherichia coli, served as control group. Univariate analysis showed that the risk factors for nosocomial infection caused by Pseudomonas aeruginosa were the use of corticosteroid, unconsciousness or craniocerebral trauma, abdominal surgery, thorax/abdomen drainage tube, mechanical ventilation, and tracheostomy [the use of corticosteroid: odds ratio (OR)=3.364, 95% confidence interval (95%CI) 1.4457.830; unconsciousness or craniocerebral trauma: OR=4.026, 95%CI 1.54510.490; abdominal surgery: OR=0.166, 95%CI 0.0680.403; thorax/abdomen drainage tube: OR=0.350, 95%CI 0.1500.818;tracheostomy: OR=4.095, 95%CI 1.63810.740]. Multivariate analysis showed that the independent risk factors of nosocomial infection caused by Pseudomonas aeruginosa in ICU were: the use of corticosteroid and mechanical ventilation [the use of corticosteroid: OR=3.143, 95%CI 1.1158.856; mechanical ventilation: OR=3.195, 95%CI 1.6076.353, P<0.05 and P<0.01]. Conclusion The independent risk factors of nosocomial infection caused by Pseudomonas aeruginosa in ICU are the use of corticosteroid and mechanical ventilation. Measures should be taken to take care of the risk factors in order to prevent nosocomial infection caused by Pseudomonas aeruginosa in ICU.     

Hypertonic nasogastric tube feedings: do they cause diarrhea?

Hypertonic NG tube feeding in hospitalized patients, whether on the hospital ward or in the ICU, is considered a common etiology of diarrhea. To evaluate the accuracy of this assumption, five normal volunteers, ten hospitalized postoperative patients with head and neck cancer, and 24 ICU patients were given hypertonic (690 mosm), low residue, lactose-free tube feedings starting at 30 kcal/kg.day. There was no prior history of diarrhea in any of the groups studied. There was a significant difference in albumin levels between the three groups, with an average albumin of 2.8 g/dl in the ICU patient group; different from 4.5 g/dl present in both the normal volunteer and non-ICU hospitalized patient groups (general linear models procedure from SAS, p less than .05) (Duncan test). Diarrhea was not present in the normal volunteers or non-ICU patients during the feedings, but did occur in 3/24 ICU patients. This difference was not significant. The three patients with diarrhea had an average albumin level of 3.0 g/dl, while the other ICU patients had an average albumin of 2.7 g/dl. We conclude that hypertonic NG tube feedings do not cause diarrhea in normal volunteers or postoperative head and neck cancer patients. However, in a small statistically insignificant percent of mechanically ventilated ICU patients, this regimen may cause diarrhea although no risk factors can be identified.     

机械通气老年患者院内气管支气管炎危险因素分析

目的 探讨机械通气老年患者并发院内气管支气管炎（NTB）的危险因素，为制定院内感染防治措施提供流行病学资料和科学依据。方法 应用前瞻性队列研究方法，观察2002年10月-2004年7月收治上海复旦大学附属中山医院外科重症监护室（SICU）内的老年机械通气患者的临床资料，进行单因素和多因素Logistic回归分析。结果 符合标准的66例SICU内机械通气老年患者有35例发生NTB（发生率为53．03％）。NTB组和非NTB组在低白蛋白血症、鼻饲情况、机械通气时间、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、抗生紊使用种数以及住SICU时间方面差异均有显著性（P〈0．05或P〈0．01）。单因素分析显示：鼻饲、低白蛋白血症、机械通气时间〉4d、住SICU时间〉9d、抗生素使用种数增加以及APACHEⅡ评分〉9分是NTB发生的重要危险因素;Logistic多因素回归分析显示：鼻饲、机械通气时间〉4d、抗生素使用种数〉2种是NTB的独立发病危险因素。结论 SICU内机械通气老年患者NTB的发生率较高，是影响患者预后的重要因素之一。机械通气时间延长、ICU内住院时间延长、低白蛋白血症、高APACHEⅡ评分、大量使用抗生素等是NTB发生的重要危险因素。     

Isotonic nasogastric tube feedings: do they cause diarrhea?

NG tube feedings in hospitalized patients, whether in a ward or ICU, are considered a common etiology of diarrhea. To evaluate the accuracy of this assumption, 13 hospitalized postoperative patients with head and neck cancer, 11 ICU patients, and five healthy volunteers were given isotonic, low-residue, lactose-free tube feedings starting at 30 kcal/kg.day. There was no prior history of diarrhea in any patient studied. There was a significant difference in both albumin levels and diarrhea incidence in the three groups (analysis of variance, p less than .05). Diarrhea occurred in four of 11 ICU patients while receiving feedings, but not in the healthy volunteers or non-ICU patients. The four patients with diarrhea had an average albumin level of 2.8 g/dl, while the other ICU patients had an average albumin of 2.6 g/dl. We conclude that isotonic NG tube feedings do not cause diarrhea in healthy volunteers or postoperative head and neck cancer patients. However, in some mechanically ventilated ICU patients, this regimen may cause diarrhea even though no risk factors can be clearly identified.     

Gastrointestinal dysfunction among intensive care unit patients

This study used the Acute Physiological and Chronic Health Evaluation (APACHE II) system to select two groups of ICU patients with comparable risk of hospital death to evaluate the importance of GI dysfunction, defined as failure to tolerate enteral nutrition (EN), as a prognostic factor. In our ICU, patients who have not undergone recent bowel surgery are treated by EN. Those patients who cannot tolerate EN are treated by total parenteral nutrition (TPN). One hundred and eleven patients who tolerated EN (functioning gut) and 97 TPN patients who failed to tolerate EN (GI dysfunction) were studied. The mean APACHE II scores of the two groups were 17.7 +/- 6.5 (SD) and 17.7 +/- 5.1, respectively. The observed mortality of patients with GI dysfunction (51%) was significantly higher (p less than .0005) than that of patients with a functioning gut (25%). This was associated with significantly poorer APACHE II mean BP, oxygenation, and creatinine scores among the GI dysfunction patients. Our results suggest that shock, ischemia, and hypoxemia, in addition to causing impairment of renal function, may bring about changes in the GI tract, evident clinically only as a failure to tolerate EN, which have an adverse effect on the prognosis of ICU patients so affected.     

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

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7d的病历资料进行回顾性分析,描述研究对象在ICU住院7d内胃残余量的变化趋...     

Grasping the nutritional situation: a grounded theory study of patients' experiences in intensive care

Aim and objectives:  The aim of this study was to provide a theoretical understanding of nutritional experiences for patients with enteral nutrition (EN) during their stay in the intensive care unit (ICU).
Background:  It is well known that EN can result in underfeeding for patients in ICUs. How the patients experience their nutritional care during their stay in the ICU remains somewhat unclear.
Design and methods:  In this study, a grounded theory approach was chosen to conduct and analyse 14 interviews with patients and 21 observations of nutritional care during the patients' stay in an ICU.
Findings:  The core category 'grasping nutrition during the recovery process' was reflected in, and related to, the categories 'facing nutritional changes', 'making sense of the nutritional situation' and 'being involved with nutritional care'. While grasping the nutrition, the patients were emotionally shifting between worry, fear and failure, and relief and hope. Turning points were having the appetite back, getting rid of the feeding tube and regaining a functioning gut.
Conclusions:  The patients' views of nutritional care during their stay in the ICU may contribute to understanding of how patients make sense of their nutritional changes and how they are involved in their nutritional care. This study shows that grasping the nutrition can be a way to regain some control in a situation where the patients are highly dependent on professional care. Further research is needed to develop this substantive theory in other intensive care settings to support patients' nutritional journey in intensive care.
Relevance to clinical practice:  Nurses can promote patients' abilities to grasp their nutritional situation during their recovery process. There is a need to focus not only on the patients' physical needs but also on their emotional and social needs.     

Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications

OBJECTIVE: To study the frequency of and risk factors for increased gastric aspirate volume (GAV) and upper digestive intolerance and their complications during enteral nutrition (EN) in critically ill patients. DESIGN: Prospective observational study. SETTING: Intensive care unit (ICU) in a general hospital. PATIENTS: A total of 153 patients with nasogastric tube feeding. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Upper digestive intolerance was considered when GAV was between 150 and 500 mL at two consecutive measurements, when it was >500 mL, or when vomiting occurred. Forty-nine patients (32%; 95% confidence interval [CI], 25%-42%) presented increased GAV after a median EN duration of 2 days (range, 1-16 days), and 70 patients (46%; 95% CI, 38%-54%) presented upper digestive intolerance. Independent risk factors for high GAV were GAV >20 mL before the start of EN (odds ratio [OR], 2.16; 95% CI, 1.11-4.18; p =.02), GAV >100 mL during EN (OR, 1.49; 95% CI, 1.01-2.19; p <.05), sedation during EN (OR, 1.78; 95% CI, 1.17-2.71; p =.007), use of catecholamines during EN (OR, 1.81; 95% CI, 1.21-2.70; p =.004). Complications related to high GAV were a lower feed intake (15 +/- 7 vs. 19 +/- 8 kcal/kg/day; p =.0004) and vomiting (53% vs. 23%; p =.0002). Complications related to upper digestive intolerance were the development of pneumonia (43% vs. 24%; p =.01), a longer ICU stay (23 +/- 21 vs. 15 +/- 16 days; p =.007), and a higher ICU mortality (41% vs. 25%; p =.03), even after adjustment for Simplified Acute Physiology Score II (OR, 1.48; 95% CI, 1.04-2.10; p =.028). CONCLUSION: In ICU patients receiving nasogastric tube feeding, high gastric aspirate volume was frequent, occurred early, and was more frequent in patients with sedation or catecholamines. High gastric aspirate volume was an early marker of upper digestive intolerance, which was associated with a higher incidence of nosocomial pneumonia, a longer ICU stay, and a higher ICU mortality.     

ICU患者肠内营养性腹泻影响因素分析

目的：探讨ICU患者肠内营养性腹泻的影响因素,为制定护理对策提供依据。方法：选取ICU住院患者116例,按其发生肠内营养性腹泻与否分成腹泻组62例,非腹泻组54例。对两组患者的疾病严重程度、排便、用药情况进行调查,并对数据进行单因素和多因素Logistic回归分析,找出发生肠内营养性腹泻的原因。结果：Logistic回归分析发现,年龄、应用抗生素、胃动力学药、抗酸药、钾剂、益生菌是肠内营养性腹泻的影响因素,其中益生菌应用是ICU肠内营养性腹泻患者的保护性因素,OR值为0.865,年龄、应用抗生素、胃动力学药、抗酸药、钾剂是肠内营养性腹泻的危险因素,OR值均大于1。结论：年龄、应用抗生素、胃动力学药、抗酸药、钾剂是ICU肠内营养性腹泻的主要危险因素,临床应尽量避免危险因素以提高营养支持的耐受性。