老年急性脑梗死患者肠内营养治疗后胃肠不耐受与生活质量的相关性

Correlation of gastrointestinal intolerance and quality of life in elderly patients with acute cerebral infarction undergoing enteral nutrition

【摘要】目的 探讨老年急性脑梗死患者肠内营养(EN)治疗后胃肠不耐受的影响因素,分析胃肠不耐受与生活质量的相关性。方法 回顾性分析2021年1月至2023年12月于南京医科大学第一附属医院进行EN支持治疗的160例老年急性脑梗死患者的临床资料,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),记录两组患者临床资料及生活质量情况。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ²检验进行组间比较。采用多因素logistic回归模型分析影响老年急性脑梗死患者EN治疗后胃肠不耐受的相关因素。老年急性脑梗死患者EN治疗后胃肠不耐受与生活质量的相关性采用Spearman秩相关性分析。结果 治疗前两组患者餐后2h血糖(2hPG)、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、情绪紧张、脑梗死后继发感染情况比较,差异有统计学意义(P＜0.05)。治疗后观察组物质生活状态、心理功能、躯体功能、社会功能评分均较对照组更高(P＜0.05)。多因素logistic回归分析显示,2hPG≥11.1mmol/L(OR=6.253,95%CI 1.604～24.367)、血清白蛋白＜35 g/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)及脑梗死后继发感染(OR=4.100,95%CI 1.209～13.903)是影响老年急性脑梗死患者EN治疗后胃肠不耐受的独立危险因素(P＜0.05)。Spearman秩相关性分析发现,老年急性脑梗死患者EN治疗后胃肠不耐受与生活质量中物质生活状态、心理功能、躯体功能及社会功能均呈显著负相关(r_s=-0.734,-0.664,-0.484,-0.628；P＜0.05)。结论 2hPG≥11.1mmol/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、情绪紧张及脑梗死后继发感染是影响老年急性脑梗死患者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定基础。

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

【Abstract】Objective To explore the influencing factors for gastrointestinal intolerance after enteral nutrition (EN) treatment in elderly patients with acute cerebral infarction (ACI), and analyze the correlation between the intolerance and quality of life (QoL). Methods A retrospective study was conducted on 160 elderly ACI patients undergoing EN support therapy in our hospital from January 2021 to December 2023. After EN treatment, they were assigned into an observation group (with gastrointestinal intolerance, n=69) and a control group (gastrointestinal tolerance, n=91). The general clinical data and QoL status were recorded in the two groups. SPSS statistics 22.0 was used for data analysis. Depending on data type, t test orχ² test was employed to compare the data between the groups, and multivariate logistic regression analysis was utilized to identify the related factors affecting gastrointestinal intolerance after EN treatment in the ACI elderly patients. Spearman rank correlation analysis was applied to analyze the correlation between gastrointestinal intolerance and QoL in the patients. Results There were significant differences between the two groups before EN treatment in terms of 2-hour postprandial plasma glucose (2hPG), serum albumin, use of sedative drugs and vasoactive drugs, intra-abdominal pressure (IAP), central venous pressure (CVP), start time of EN, neurological dysfunction, emotional stress, and secondary infection after cerebral infarction (P<0.05). After treatment, the observation group had obviously higher scores of material living state, psychological function, physical function, and social function than the control group (P<0.05). Multivariate logistic regression analysis showed that 2hPG ≥11.1 mmol/L (OR=6.253,95%CI 1.604-24.367), serum albumin <35 g/L (OR=4.679,95%CI 1.189-18.413), IAP ≥15 mmHg (OR=3.823,95%CI 1.207-12.103), CVP ≥12 cmH₂O (OR=4.683,95%CI 1.209-18.144), start time of EN ≥3 d (OR=3.939,95%CI 1.164-13.331), neurological dysfunction (OR=5.468,95%CI 1.331-22.470), emotional stress (OR=3.995,95%CI 1.180-13.519), and secondary infection after cerebral infarction (OR=4.100,95%CI 1.209-13.903) were independent risk factors for gastrointestinal intolerance in elderly ACI patients after EN treatment (P<0.05). Spearman rank correlation analysis found that gastrointestinal intolerance was negatively correlated with material living state, psychological function, physical function, and social function in the patients (r_s=-0.734, -0.664, -0.484, -0.628; P<0.05). Conclusion 2hPG ≥11.1 mmol/L, serum albumin <35 g/L, IAP ≥15 mmHg, CVP ≥12 cmH₂O, start time of EN ≥3 d, neurological dysfunction, emotional stress, and secondary infection after cerebral infarction are independent risk factors for gastrointestinal intolerance after EN treatment in elderly ACI patients. Clinically, management of the above-mentioned factors needs to be strengthened to lay a foundation for nutritional support and improvement of the QoL in the patients.

This work was supported by the National Natural Science Foundation of China (82172698) and the Key Medical Talents Foundation ofJiangsu Province (2021002).