| Objective: To investigate and analyze the current situation of feeding intolerance in elderly patients with mechanical ventilation and explore its influencing factors,so as to provide theoretical basis for clinical identification of high-risk groups with feeding intolerance and reference basis for formulation of early intervention measures.Methods: In this study,elderly mechanically ventilated patients who had enteral nutrition support therapy implemented in the general ICU and neurosurgical ICU of a tertiary level a hospital in Anhui Province from June 2021 to December 2022,and 202 patients who met the criteria of nanotoxoid were selected as study subjects.Data collection was conducted using general condition data checklist,enteral nutrition intolerance status checklist for 5 days,and data were entered into Excel software after double checking of data in original paper version,statistical analysis was performed using spss25.0,and independent samples t-test,rank sum test and chi square test were used for univariate analysis,Factors found to be significant(P < 0.05)in the univariate analysis of feeding intolerance in older patients on mechanical ventilation were included in the binary logistic regression equation for multivariate analysis.Results: Among the 202 elderly patients with mechanical ventilation treated with enteral nutrition,69 were female and 133 were male.108 patients were 60-75 years old,68 patients were 75-90 years old,and 26 patients were ≥90 years old.There were 43 patients with circulatory system diseases,accounting for 21.3%,20 patients with digestive system diseases,accounting for 9.9%,10 patients with endocrine system diseases,accounting for 5%,38 patients with respiratory system diseases,accounting for 18.8%,57 patients with nervous system diseases,accounting for 28.2%,and 24 patients with other diseases,accounting for 11.9%.Occurrence of feeding intolerance: Among 202 elderly patients with mechanical ventilation,102 cases had FI,with an incidence of 50.5%.In this study,the high incidence of feeding intolerance occurred in the first to third days of EN,29.4% of the patients developed feeding intolerance on the second day of EN,and gradually decreased after the third day of EN.86 cases(84.3%)had diarrhea,6 cases(5.8%)had gastric residual volume ≥250ml,and 56 cases(54.9%)had abdominal distension.Vomiting was the most common symptom(20 cases,19.6%),aspiration was the most common symptom(8 cases,7.8%).The incidence of two gastrointestinal symptoms was the highest,accounting for51.9% of the total incidence,and the proportion of one symptom and three symptoms was38.2% and 9.9%,respectively.Results of univariate analysis: The results showed that the speed of nasal feeding,the way of catheterization,the type of EN preparation,sedative and analgesic drugs,vasoactive drugs,acid-suppressive drugs,the use of soluble dietary fiber,mechanical ventilation mode,bed elevation ≥30°,mean arterial pressure,APACHE There were significant differences in II score,PEEP,blood glucose,procalcitonin and serum albumin between the two groups(P < 0.05).Results of multivariate analysis: Fifteen factors that were statistically significant in univariate analysis were included as independent variables and whether the occurrence of fi was included as dependent variable in the regression model,and binary logistic regression showed that nasogastric feeding rate ≥ 40 ml(OR = 5.826,95% CI = 2.565-13.234,P = 0.000),use of vasoactive drugs(OR = 2.581,95% CI = 1.163-5.73,P = 0.02),high positive end respiratory pressure(OR = 1.218,95% CI = 1.025-1.447,P = 0.025)Serum albumin(OR = 0.952,95% CI = 0.912-0.994,P = 0.025),elevation of the head of the bed ≥ 30 °(OR= 0.3,95% CI = 0.097-0.994,P = 0.036),and use of soluble dietary fiber(OR = 0.325,95% CI = 0.14-0.755,P = 0.009)were independent influences of feeding intolerance in elderly mechanically ventilated patients with statistically significant differences(P < 0.05).Conclusions: Enteral nutrition feeding intolerance occurs in 50.5% of elderly mechanically ventilated patients,and diarrhea and abdominal distension are the main clinical manifestations.The time of high incidence of enteral nutrition feeding intolerance was 1-3 days after the start of EN.Among them,nasal feeding speed ≥ 40 ml,use of vasoactive drugs,and high positive end-expiratory pressure were the independent risk factors for enteral nutrition feeding intolerance in elderly patients with mechanical ventilation.Head of bed elevation ≥30°,use of soluble dietary fiber and normal serum albumin are independent protective factors for feeding intolerance in elderly patients with mechanical ventilation.In clinical work,the above factors should be focused on and evaluated in elderly patients with mechanical ventilation receiving enteral nutrition,so as to formulate corresponding prevention programs and intervene as soon as possible to avoid the occurrence of feeding intolerance. |
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