综合重症监护治疗病房患者发生腹泻的相关因素分析

目的 分析综合重症监护治疗病房(ICU)患者发生腹泻的相关因素,以指导临床制订最佳治疗方案。方法对2001年1月-2002年12月入住山东省聊城市人民医院综合ICU的危重患者共735例进行回顾性分析,结合文献,综合评价ICU内腹泻发生的原因。结果 735例中,入住ICU前无腹泻,入住24 h后发生腹泻者为86例,发生率为11.70％。引起腹泻的原因主要为:不适当肠内营养51例次(占59.30％),肠道感染18例次(占20.93％),滥用广谱抗生素15例次(占17.44％),大量使用胃肠动力药物11例次(占12.79％),与饥械通气有关者5例次(占5.81％)。而且综合ICU内发生腹泻患者的年龄[平均(57.71±13.40)岁]、急性生理学与慢性健康状况Ⅱ评分[平均(21.51±4.90)分]及住ICU时间[平均(8.0±1.2)d]均明显高于同期入住综合ICU未发生腹泻患者[分别为(51.20±11.31)岁,(12.01±1.20)分和(4.0±1.0)d,P均<0.05],并且发生腹泻的原因不同于普通病房患者引起腹泻的病因。结论 综合ICU患者发生腹泻有其特点和原因,应予以高度重视。

Clinical analysis of the factors related to diarrhea in intensive care unit

OBJECTIVE: To assess the causative factors of diarrhea in intensive care unit(ICU) patients for the purpose of providing a scientific basis for the treatment regime. METHODS: The factors related to diarrhea in patients in the ICU of Liaocheng People's Hospital were studied by analyzing the features of 86 patients who developed diarrhea among 735 patients admitted in 2 years (from January 2001 to December 2002). RESULTS: Among the total of 86 patients(11.70%) who had developed diarrhea, 51 had received enteral nutrition improperly, accounting for 59.30%; 18 patients had suffered from intestinal tract infection, accounting for 20.93%. In 15 patients diarrhea occurred after the administration of broad-spectrum antibiotics, accounting for 17.44%. In 11 patients it was due to the use of drugs which enhanced motility of gastrointestinal tract, and this accounted for 12.79%. Finally, in 5 patients, diarrhea was thought to be related to the mechanical ventilation, and it accounted for 5.81%. The mean age of the patients was (57.71+/-13.40) years, the average acute physiology and chronic health evaluation (APACHE II) was (21.51+/-4.90)scores, and the mean length of staying in the ICU was (8.0+/-1.2) days, which was longer than that of patients without the complication of diarrhea ((51.20+/-11.31)years, (12.01+/-1.20) scores, (4.0+/-1.0) days respectively, all P<0.01). The pathogenic factors related to diarrhea complicating ICU patients seemed to be different from that in other patients. CONCLUSION: The causative factors of diarrhea in ICU patients appear to be different from that in other patients, and special attention should be given in order to avoid it.