The Nursing Countermeasures And Analysis Of Related Factors With Enteral Feeding Intolerance In Elderly Septic Patients

Objectives1.To describe the status of feeding intolerance during enteral nutrition in elderly septic patients as a reference for formulate corresponding management measures.2.To determine the risk factors of enteral nutrition intolerance and the predictive value of related indicators in elderly septic patients as a reference for the formula of corresponding countermeasures.3.To propose nursing countermeasures of enteral nutrition as a reference for clinical practice.MethodsData of Two-hundred and twelve elderly septic patients.Undergoing enteral nutrition therapy from the People's Hospital of Jiangsu University from January 1,2014 to December 31,2016 were retrospectively collected.Patients were divided into feeding tolerance group and feeding intolerance group.Patients characteristics such as gender,age,past history,primary disease,tolerability during the EN period and the data on the factors influencing feeding intolerance were collected.Univariate analysis and binary logistic regression analysis were used to investigate the influencing factors of feeding intolerance during the enteral nutrition in elderly septic patients.Simultaneously,using the area under the receiver operating characteristic curve(ROC)to assess the predictive value of nutritional indicators on elderly septic patients' feeding intolerance.Results1.The occurrence rate of feeding intolerance in elderly septic patients during enteral nutrition was 39.62%,most of the cases occurred during the 1~4 days of enteral nutrition and intolerance days are mostly 1~3 days.2.Univariate analysis: It showed that APACH? score(P=0.000),daily doses of enteral nutrition formula(P=0.000),mechanical ventilation(P=0.004),sedatives(P=0.005),analgesic(P=0.009),antacids(P=0.041),antibiotics(P=0.000),potassiumpreparations(P=0.001),intra-abdominal pressure(P=0.001),blood glucose(P=0.002),procalcitonin(P=0.003),serum albumin(P=0.000),prealbumin(P=0.000)were influencing factors of feeding intolerance during enteral nutrition in the elderly septic patients.3.Mutivariate analysis: It showed that APACH? score(OR=4.012),daily doses of enteral nutrition formula(OR=1.004),antibiotics(OR=4.028),intra-abdominal pressure(OR=3.389),blood glucose(OR=1.235),procalcitonin(OR = 1.032),serum albumin(OR=0.909)and prealbumin(OR=0.981)were independent risk factors for feeding intolerance in elderly septic patients(P <0.05).The area under the ROC curve for serum albumin was 0.726,the 95% confidence interval for the area under the curve was(0.656,0.795),the area under the ROC curve for serum prealbumin was 0.781,and the 95% confidence interval for the area under the curve was(0.715,0.846).Prealbumin has better predictive value than albumin for feeding intolerance in elderly septic patients.Conclusions1.The incidence of enteral feeding intolerance in elderly septic patients was high,and more influential factors.Clinical staff should pay close attention to enteral nutrition status in elderly septic patients,assess the gastrointestinal symptoms timely and provide more frequent observations.2.APACH? score,daily doses of enteral nutrition formula,mechanical ventilation,sedatives,analgesic,antacids,antibiotic classes,oral potassium preparations,intra-Abdominal pressure,procalcitonin,blood glucose,serum albumin and prealbumin were influencing factors of feeding intolerance during enteral nutrition in the elderly septic patients.clinicians should pay more attention to the above factors.3.It appears to be a superior prognostic marker for the enteral feeding intolerance in elderly septic patients,clinical staff should pay close attention to prealbumin levels and take interventions to reduce the incidence of feeding intolerance.