老年急性脑梗死EN治疗后胃肠不耐受影响因素及与生活质量的相关性分析
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南京医科大学第一附属医院(江苏省人民医院)急诊与危重症医学科

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国家自然科学基金资助项目(82172698) 江苏省医学重点人才基金项目(2021002)


Influence factors of gastrointestinal intolerance and its correlation with quality of life in elderly patients with acute cerebral infarction after EN treatment
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    摘要:

    摘要:目的 探讨老年急性脑梗死EN治疗后胃肠不耐受影响因素及与生活质量的相关性。方法 回顾性2021年1月至2023年12月在我院进行肠内营养(EN)支持治疗的160例老年急性脑梗死患者一般临床资料,将EN治疗后胃肠不耐受者纳入观察组(n=69),将EN治疗后胃肠耐受者纳入对照组(n=91),记录两组一般临床资料及生活质量水平,采用SPSS 20.0统计软件对文中数据进行分析,依据数据类型,采用t检验或χ2检验进行组间比较,采用Logistic回归分析影响老年急性脑梗死EN治疗后胃肠不耐受相关因素,采用Spearman法分析老年急性脑梗死EN治疗后胃肠不耐受与生活质量相关性。结果 两组血糖、血清白蛋白、使用镇静药物、使用血管活性药物、腹内压、中心静脉压、EN开始时间、神经功能紊乱、卧床时间、情绪紧张、脑梗死后继发感染资料比较差异显著(χ2=7.364、5.807、4.874、7.453、8.616、9.233、11.284、6.200、4.690、9.889、5.149、8.247,P<0.05);Logistic回归分析发现血糖≥11mmol/L(OR:6.253,95%CI:1.604~24.367)、血清白蛋白<35g/L(OR:4.679,95%CI:1.189~18.413)、腹内压≥15mmHg(OR:3.823,95%CI:1.207~12.103)、中心静脉压≥12cmH2O(OR:4.683,95%CI:1.209~18.144)、EN开始时间≥3d(OR:3.939,95%CI:1.164~13.331)、神经功能紊乱(OR:5.468,95%CI:1.331~22.470)、情绪紧张(OR:3.995,95%CI:1.180~13.519)、脑梗死后继发感染(OR:4.100,95%CI:1.209~13.903)影响老年急性脑梗死EN治疗后胃肠不耐受的独立危险因素(P<0.05);观察组治疗后物质生活状态、心理功能、躯体功能、社会功能评分均较对照组更高(t=11.665、8.952、7.856、10.383,P<0.05);Spearman相关性分析发现,老年急性脑梗死EN治疗后胃肠不耐受与生活质量呈显著负相关(r=-0.734、-0.664、-0.484、-0.628,P<0.05)。结论 血糖≥11mmol/L、血清白蛋白<35g/L、腹内压≥15mmHg、中心静脉压≥12cmH2O、EN开始时间≥3d、神经功能紊乱、情绪紧张、脑梗死后继发感染影响老年急性脑梗死EN治疗后胃肠不耐受的独立危险因素,临床需加强对上述因素的管理,为营养支持及生活质量改善奠基。

    Abstract:

    Abstract: Objective To investigate the influence factors of gastrointestinal intolerance and its correlation with quality of life in elderly patients with acute cerebral infarction after EN treatment. Methods The general clinical data of 160 elderly patients with acute cerebral infarction who received enteral nutrition (EN) support therapy in our hospital from January 2021 to December 2023 were reviewed. Gastrointestinal intolerance after EN treatment was included in the observation group (n=69), and gastrointestinal intolerance after EN treatment was included in the control group (n=91). The general clinical data and life quality of the two groups were recorded, and the data were analyzed by SPSS 20.0 statistical software. According to the data type, T-test or χ2 test were used to compare the data between the groups, and Logistic regression was used to analyze the related factors affecting gastrointestinal intolerance after EN treatment in the elderly with acute cerebral infarction. Spearman method was used to analyze the correlation between gastrointestinal intolerance and quality of life in elderly patients with acute cerebral infarction after EN treatment. Result There were significant differences in blood glucose, serum albumin, use of sedative drugs, use of vasoactive drugs, intra-abdominal pressure, central venous pressure, EN onset time, nervous dysfunction, bed time, emotional tension, and secondary infection after cerebral infarction between the two groups(χ2=7.364、5.807、4.874、7.453、8.616、9.233、11.284、6.200、4.690、9.889、5.149、8.247,P<0.05); Logistic regression analysis found that blood glucose ≥11mmol/L (OR: 6.253, 95%CI: 1.604-24.367), serum albumin < 35g/L (OR: 4.679, 95%CI: 1.189-18.413), internal abdominal pressure ≥15mmHg (OR: 3.823, 95%CI: 1.207-12.103), central venous pressure ≥12cmH2O (OR: 4.683, 95%CI: 1.209-18.144), EN onset time ≥3d (OR: 3.939, 95%CI: 1.164-13.331), neurological disorders (OR: 5.468, 95%CI: 1.331 ~ 22.470), emotional stress (OR: 3.995, 95%CI: 1.180 ~ 13.519), secondary infection after cerebral infarction (OR: 4.100, 95%CI: 1.209-13.903) Independent risk factors affecting gastrointestinal intolerance in elderly patients with acute cerebral infarction after EN treatment (P < 0.05); After treatment, the scores of material life status, psychological function, physical function and social function in the observation group were higher than those in the control group (t=11.665, 8.952, 7.856, 10.383, P < 0.05). Spearman correlation analysis showed that gastrointestinal intolerance was significantly negatively correlated with quality of life in elderly patients with acute cerebral infarction after EN treatment (r=-0.734, -0.664, -0.484, -0.628, P < 0.05). Conclusion Blood glucose ≥11mmol/L, serum albumin < 35g/L, internal abdominal pressure ≥15mmHg, central venous pressure ≥12cmH2O, EN initiation time ≥3d, nervous dysfunction, emotional tension and secondary infection after cerebral infarction are independent risk factors for gastrointestinal intolerance after EN treatment. Clinical management of the above factors should be strengthened to lay the foundation for nutritional support and improvement of life quality.

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  • 收稿日期:2024-04-12
  • 最后修改日期:2024-05-22
  • 录用日期:2024-05-30
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