肠内营养喂养不耐受与慢阻肺急性加重期机械通气患者并发ICU获得性衰弱的相关性研究

目的探讨肠内营养喂养不耐受(FI)与慢性阻塞性肺疾病(简称慢阻肺)急性加重期机械通气患者并发ICU获得性衰弱(ICU-AW)的相关性。方法收集254例慢阻肺急性加重期患者作为观察对象,根据是否发生FI分为FI组132例和非FI组122例,统计肠内营养FI和ICU-AW发生情况。采用生存分析中的Kaplan-Meier(K-M)生存曲线,分析肠内营养FI对慢阻肺急性加重期机械通气患者并发7d ICU-AW的影响。采用Logistic回归分析慢阻肺急性加重期机械通气患者发生FI的影响因素。结果慢阻肺急性加重期机械通气患者肠内营养FI和ICU-AW的发生率分别为52.0%和59.8%。K-M分析显示,FI组患者7d内ICU-AW发生率高于非FI组(P<0.05)。Logistic回归分析显示,年龄≥65岁(OR=5.998,95%CI:3.057~11.766)、APACHEⅡ评分(OR=1.150,95%CI:1.080~1.225)、高血糖(OR=2.090,95%CI:1.091~4.005)、放置鼻胃管(OR=2.098,95%CI:1.097~4.015)、床头未抬高≥30°(OR=4.151,95%CI:1.951~8.832)和营养液输注速度(OR=1.049,95%CI:1.019~1.080)均是慢阻肺急性加重期机械通气患者发生FI的危险因素(P均<0.05)。结论慢阻肺急性加重期机械通气患者肠内营养FI和ICU-AW发生率高,FI会增加其ICU-AW发生风险。年龄≥65岁、APACHEⅡ评分、高血糖、放置鼻胃管、床头未抬高≥30°和营养液输注速度均是慢阻肺急性加重期机械通气患者发生FI的危险因素,应根据危险因素进行针对性干预。

Study on relationship between enteral nutrition feeding intolerance and ICU acquired weakness in mechanical ventilation patients with chronic obstructive pulmonary disease during acute exacerbation

Objective To study the relationship between enteral nutrition feeding intolerance(FI)and ICU acquired weakness(ICU-AW)in mechanical ventilation patients with COPD during acute exacerbation(AECOPD).Methods 254 AECOPD patients with mechanical ventilation were collected as observational objects and were divided into the FI group(n=132)and the non-FI group(n=122)according to the occurrence of FI.Kaplan Meier(K-M)survival curve of survival analysis was used to analyze the effect of enteral nutrition FI on occurrence of 7-day ICU-AW in AECOPD patients with mechanical ventilation.Logistic regression was used to analyze the influencing factors of FI in AECOPD patients with mechanical ventilation.Results The incidence of FI and ICU-AW were 52.0%and 59.8%respectively in AECOPD patients with mechanical ventilation.K-M analysis showed that the incidence of ICU-AW within 7 days in the FI group was higher than that that in the non-FI group(P<0.05).Logistic regression analysis showed that age≥65 years(OR=5.998,95%CI 3.057-11.766),APACHEⅡscore(OR=1.150,95%CI 1.080-1.225),hyperglycemia(OR=2.090,95%CI 1.091-4.005),nasogastric tube placement(OR=2.098,95%CI 1.097-4.015),without bed head-raising≥30 degrees(OR=4.151,95%CI 1.951-8.832)and nutrient infusion speed(OR=1.049,95%CI 1.019-1.080)were risk factors for FI in AECOPD patients with mechanical ventilation(all P<0.05).Conclusion AECOPD patients with mechanical ventilation have higher incidences of FI and ICU-AW,and the presence of FI can increase the risk of ICU-AW.Age≥65 years old,APACHEⅡscore,hyperglycemia,nasogastric tube placement,without bed head-raising≥30°and nutrient infusion speed are risk factors of FI in AECOPD patients with mechanical ventilation.Targeted intervention should be carried out according to risk factors.