危重患者急性胃肠损伤现状及影响因素的调查研究

目的了解危重患者急性胃肠的损伤状况,探讨其可能的影响因素。方法采用多中心前瞻性观察性研究方法,依据急性胃肠损伤(AGI)分级标准,统一设计调查表收集AGI状况和相关临床资料。调查对象为8家三级甲等医院监护室自2013年10月至2014年3月连续收入的危重患者。采用广义估计方程对AGI的相关因素进行筛选和检验。结果共有509例危重患者入选;发生AGIⅠ级占总数的54.18%,Ⅱ级以上的胃肠功能障碍占总数45.82%;在胃肠道症状中,排名第1位和第2位的是胃肠音减弱和胃肠音消失。多因素回归分析显示,影响AGI严重程度的危险因素有较长留驻ICU时间、通便措施、机械通气和休克,保护因素为肠内营养。结论危重患者AGI的发生率较高,在防治中应重点控制可加重胃肠损伤的危险因素,并重视肠内营养的开展。

A multiple-center observational study of acute gastrointestinal injury and its influential factors in critically ill patients

Objective This paper investigates acute gastrointestinal injury(AGI) in critically ill patients and the influencing factors of AGI.Methods A multiple center prospective observational study of AGI was conducted in which 509 patients were enrolled.The patients of AGI grade Ⅰ accounted for 54.18％ of the total,patients above AGI grade Ⅱ accounted for 45.82％.The most occurrent gastrointestinal symptoms were the decrease of gastrointetinal sound (GIS) and the absence of GIS.A clinical case report form was designed to collect the clinical data and evaluate the AGI grades.The data of patients in intensive care unit(ICU) of eight tertiary hospitals in Beijing from October 2013 to March 2014 were collected and analyzed.The relevant factors of AGI were screened and analyzed by generalized estimating equation.Results Five hundred and nine patients were enrolled.The patients of AGI grade Ⅰ accounted for 54.18％ of the total,patients above AGI grade Ⅱ accounted for 45.82％.The most occurrent gastrointestinal symptoms were the decrease or absence of gastrointetinal sound (GIS).The generalized estimating equation showed that more ICU days,laxative drugs,mechanical ventilation and shock were risk factors to the AGI grade while enteral feeding was a protective factor.Conclusions The incidence of AGI was high in critically ill patients.To prevent and treat AGI,the factors aggravating gastrointestinal injury should be controlled,and enteral nutrition should be paid special attention to.