Assessment And Management Of Early Enteral Nutrition Tolerance In Patients With Sepsis Based On Feeding Process

ObjectiveThis study explore the impacts of early enteral nutrition tolerance assessment and management based on enteral nutrition feeding process of critically ill patients on enteral nutrition tolerance,nutritional status and clinical outcome in patients with sepsis.With the aim of improving enteral nutrition tolerance and improving prognosis provide a scientific basis for the rational implementation of early enteral nutrition in patients with sepsis and the systematic evaluation and management of medical staff.MethodsUsing a fixed point continuous sampling method,108 patients who were diagnosed with sepsis and received early enteral nutrition in the wards A and B of Intensive Care Unit(ICU)of Qingdao Municipal Hospital of Shandong Province from May 1,2018 to August 31,2019 were selected as the research objects,they were divided into control group(n=51)and test group(n=57)according to the order of admission.The control group received early enteral nutrition treatment and tolerance assessment and management according to the routine enteral nutrition process,while the test group received early enteral nutrition treatment and tolerance assessment and management according to the enteral nutrition feeding process of critically ill patients.Enteral nutrition tolerance score table was used to monitor and record the tolerance index of the two groups of patients.ICU medical record management system was used to record the nutrition index and clinical index of the two groups of patients.The differences of enteral nutrition tolerance(gastrointestinal symptom incidence,gastrointestinal tolerance score),nutrition indexes(body mass index,serum albumin,prealbumin,hemoglobin,the time of reaching the target feeding amount)and clinical indexes(time of living in ICU,time of mechanical ventilation,28-day mortality)were compared between the two groups of patients one week after early enteral nutrition.SPSS23.0 software was used for statistical analysis of data,mainly including independent sample t test,paired t test,chi-square test and non-parametric test.P<0.05 indicated that the difference was statistically significant.Results1.General data:There was no statistically significant difference between the general data of age,sex,acute physiology and chronic health score,nutritional risk screening score,basic disease type,enteral nutrition preparation type and enteral nutrition tube feeding route of the two groups of patients(P>0.05).2.Tolerance index:(1)Comparison of gastrointestinal symptoms between groups:There were 8 cases of aspiration and 13 cases of gastric retention in the control group,2 cases of aspiration and0 case of gastric retention in the test group,and the incidence of aspiration and gastric retention in the test group were significantly lower than those in the control group,with statistically significant difference(?~2=4.751,14.198,P<0.05).(2)Comparison of tolerance between groups:The number of cases of gastrointestinal intolerance in the control group was 18,and the intolerance rate was 35.29%.The number of cases of intolerance in the test group was 10,and the intolerance rate was 17.54%.The number of cases of intolerance and the rate of intolerance in the test group were lower than those in the control group,with statistically significant difference(?~2=4.416,P<0.05).(3)Comparison of tolerance score between groups:The gastrointestinal tolerance score of the test group was lower than that of the control group,with statistically significant difference(Z=-2.158,P<0.05).3.Nutrition indexes:(1)Comparison of nutrition indexes between groups before the start of early enteral nutrition:Compared with the control group,there was no statistically significant difference in body mass index,serum albumin,prealbumin and hemoglobin in the test group(t=1.026,1.200,1.290,1.073,P>0.05).(2)Comparison of nutrition indexes between groups one week after early enteral nutrition:The prealbumin and hemoglobin in the test group were significantly higher than those in the control group,with statistically significant difference(t=-2.022,-2.026,P<0.05).(3)Comparison of nutrition indexes of intra-group one week after early enteral nutrition:Compared with before nutrition,the body mass index,serum albumin and prealbumin in the test group increased,with statistically significant difference(t=-4.708,-2.011,-11.907,P<0.05).The prealbumin in the control group increased,with statistically significant difference(t=-2.409,P<0.05).(4)Comparison of the time of reaching target feeding amount of early enteral nutrition between groups:The time of reaching target feeding amount in the test group was lower than that in the control group,with statistically significant difference(t=2.033,P<0.05).4.Clinical indexes:After one week of early enteral nutrition,the time of living in ICU in the test group was lower than that in the control group,with statistically significant difference(t=2.000,P<0.05).Compared with the control group,the time of mechanical ventilation and the 28-day mortality of the test group were not statistically significant(t=-0.025,c~2=0.296,P>0.05).ConclusionPatients with sepsis use enteral nutrition feeding process of critically ill patients and enteral nutrition tolerance assessment and management,which can reduce the incidence of early enteral nutrition gastrointestinal intolerance symptoms and improve the tolerance of patients'enteral nutrition so as to ensure the smooth implementation of early enteral nutrition.It can shorten the time of reaching the target feeding amount,effectively improve the nutritional status of patients,shorten the time of hospitalization and promote the recovery of disease.It has important clinical guiding significance for medical staff in the treatment and evaluation management of early enteral mutrition in patients with sepsis.