论文部分内容阅读
目的：研究脑损伤患者腹泻发生率及肠内营养、抗菌药物对腹泻的影响作用。方法回顾北京天坛医院重症医学科于2012年11月~2014年11月收治的脑损伤患者，采用单因素分析筛选可能的危险因素并采用广义估计方程（Generalized Estimated Equations model）进一步评价筛选得到的危险因素对腹泻的影响。结果研究共纳入脑损伤患者421例，其中发生腹泻的患者44例，腹泻发生率为10.5%，平均在入室第7天发生，患者腹泻持续时间3（1~9）d，难辨梭状芽孢杆菌感染所致腹泻发生率为0.7%。腹泻危险因素包括：肠内营养喂养量达目标营养量70%以上（EN＞70%）（相对危险度，3.39[1.76-10.41]）、应用抗细菌药物（相对危险度，3.30[1.24-9.44]）、应用抗真菌药物（相对危险度，4.54[1.26-12.66]）。在EN＞70%患者中，随着应用抗细菌药物（相对危险度，4.66[2.09-9.36]）和抗真菌药物（相对危险度，5.59[1.62-13.86]）增加，腹泻发生率升高。结论 ICU脑损伤患者腹泻发生率为10.5%。腹泻危险因素包括EN＞70%、应用抗细菌药物、应用抗真菌药物。在EN＞70%患者中，若合并应用抗菌药物和抗真菌药物，腹泻发生率明显升高。“,”Objective To investigate the incidence of diarrhea in patients with brain injury and risk factors thereof. Methods The times of diarrhea were observed on 421 patients with brain injury admitted to ICU. Relevant medical data were collected to screen the possible risk factor s of diarrhea. Generalized Estimated Equations model was used to analyze the influence of these factors on diarrhea. Results Diarrhea was observed in 44 of the 421 patients (10.5%), and occurred on the 7th day of admission on the average with a duration of 3 (1~9) days. The incidence of Clostridium difficile infection was 0.7%. Diarrhea risk factors were enteral nutrition (EN) covering>70%of energy target [relative risk (RR), 3.39 (1.76~10.41)], antibiotics [RR, 3.30 (1.24~9.44)], and antifungal drugs [RR, 4.54 (1.26~12.66)]. EN delivery per se was not a diarrhea risk factor. In the patients receiving>60%of energy target by EN, the diarrhea risk was increased by the presence of antibiotics [RR, 4.66 (2.09~9.36)] or antifungal drugs [RR, 5.59 (1.62~13.86)]. Conclusion The incidence of diarrhea in the patients with brain injury is about ten percent. Diarrhea risk factors include EN covering >70% of energy target, antibiotics and antifungal drugs. In patients receiving >70% of energy target by EN, diarrhea risk is increased by the presence of antibiotics or antifungal drugs.