Analysis On The Status Of Tolerance To Early Enteral Nutrition And The Influencing Factors Of Feeding Intolerance In Patients With Mechanical Ventilation

Purpose:To investigate the status of early enteral nutrition and gastrointestinal tolerance in patients with mechanical ventilation.To explore the influencing factors of early enteral nutrition feeding intolerance in patients with mechanical ventilation,so as to provide the basis for early intervention to improve feeding tolerance and ensure the implementation of enteral nutrition.Materials and Methods:Choose the mechanically ventilated patients hospitalized in the department of critical care medicine in Shandong provincial Qianfoshan hospital from October 2018 to October 2019 as the object of this study.Inclusion criteria and exclusion criteria were used to screen patients admitted to ICU for mechanical ventilation,and families informed consent and compliance with the criteria were included in the study.Using a self-designed questionnaire to collect data,the early enteral nutritional tolerance of 202 patients with mechanical ventilation in ICU was observed and investigated within 5 days after admission.According to the tolerance results of enteral nutrition,the subjects were divided into the tolerance group and the intolerance group,and SPSS 22.0 was used for statistical analysis.(1)Frequency and percentage were used to describe the disease;(2)Frequency and percentage were used to describe the condition of intestinal feeding intolerance;(3)Mean±standard deviation was used to describe age,BMI,APACHE Ⅱ score,MAP,blood sugar,enteral nutrition opening time,PEEP and enteral nutrition speed.(4)Independent sample t test and one-way analysis of variance were used to analyze the effects of different factors on enteral nutritional tolerance;Logistic regression analysis was used to carry out multivariate analysis on the factors with statistical significance in the univariate analysis,and P<0.05 was regarded as the level of statistical test significance.Results:1.Incidence of early enteral feeding intolerance in patients with mechanical ventilation:among the 202 patients,138 had symptoms of enteral feeding intolerance,and the incidence of early enteral feeding intolerance ’in patients with mechanical ventilation in this study was 68.3%.2.Specific manifestations of early enteral nutritional feeding intolerance in patients with mechanical ventilation:abdominal distention accounted for 55.1%,reflux/vomiting accounted for 23.2%,diarrhea accounted for 10.14%,gastric residual volume≥250ml/6h accounted for 7.25%,and aspiration accounted for 2.90%.3.Univariate analysis of influencing factors of early enteral feeding intolerance in patients with mechanical ventilation:Age(t=3.821,P=0.001),BMI(t=3.174,P=0.012),APACHE Ⅱ score(t=9.621,P=0.004),mean arterial pressure(MAP)(t=-6.672,P=0.027),albumin(t=--4.136,P=0.003),blood glucose(t=5.002,P=0.014),use of vasoconstrictor drugs(x2=26.903,P=0.006),mechanical ventilation pattern(x2=24.775,P--0.027),enteral nutrition pathway(χ2=49.263,P=0.005),whether the head of the bed was raised≥>30°(x2=29.691,P=0.001),positive end-expiratory pressure(PEEP)(t=2.758,P=0.001),and nasal feeding speed of enteral nutrition solution(t=1.77,P=0.004)were statistically significant(P<0.05),which had an impact on the occurrence of early enteral nutrition feeding intolerance in patients with mechanical ventilation.4.Multi-factor analysis of early enteral feeding intolerance in patients with mechanical ventilation:According to Logistic regression analysis,age(OR=1.890,95%CI:1.486-3.990,P=0.019),APACHE II score(OR=2.887,95%CI:1.670-13.720,P=0.019),mean arterial pressure(OR=1.093,95%CI:1.000-1.195,P=0.049),albumin(OR=1.317,95%CI:1.081-1.604,P=0.006),vasoconstrictor(OR=3.342,95%CI:1.284-8.716,P=0.008),mechanical ventilation mode(OR=1.662,95%CI:1.166-3.648,P=0.039),head elevation>300(OR=0.775,95%CI:0.681-0.884,P=0.001)the differences of 7 factors were statistically significant(P<0.05),which were i ndependent influencing factors of early intestinal feeding intolerance in patients with mechanical ventilation.Conclusion:1.The incidence of early enteral nutritional feeding intolerance in is higher than other diseases.Medical staff should pay more attention to patients with mechanical ventilation and strengthen awareness,accurately assess the enteral nutritional status of the patients,timely identify the risk of feeding intolerance,and intervene as early as possible to avoid the occurrence of feeding intolerance.2.There are many factors can influence the early enteral nutritional feeding intolerance in patients with mechanical ventilation,which including age,BMI,APACHE II scores,mean arterial pressure,albumin,blood sugar,breathe out at the end of the positive pressure,enteral nutrition nasal feeding speed,whether to use vasoconstrictor drugs,mechanical ventilation mode,way of enteral nutrition,whether the head of a bed up acuity 30°,whether to use vasoconstrictor drugs.The head of a bed up acuity 30 ° is a protective factor,while the other factors are independent risk factors.