Investigation Of The Effects Of Common Treatment And Nursing Measures On The Occurrence Of Feeding Intolerance In Patients With Severe Traumatic Brain Injury

Background:Early enteral nutrition in patients with severe traumatic brain injury(STBI)is of great importance to their nutritional status,body recovery,and prognosis.However,patients with STBI oftentimes suffered from dysfunction in gastrointestinal absorption,barrier,and motility due to central nervous system damage,traumatic stress and other factors.In addition,patients with STBI often receive treatment of analgesics,sedatives,dehydrating agents,mechanical ventilation,and other treatment measures that may affect their gastrointestinal motility or absorption function.The fact is that the incidence of feeding intolerance(FI)for STBI patients with above treatments is significantly higher than others with severe trauma and get more difficulty in the implementation of early enteral nutrition.In order to improve gastrointestinal dysfunction,reduce the incidence of feeding intolerance and promote the smooth implementation of enteral nutrition,a variety of medical and nursing strategies has been taken to improve gastrointestinal function and prevent and cure feeding intolerance in patients with STBI.Although the incidence has been reduced to a certain extent,it is still at a high level.Through literature analysis and clinical investigation,we found that the studies on the effects of various medical and nursing measures on feeding intolerance in STBI patients are still very limited.However,there are few comparative studies on the measures to improve gastrointestinal function and the effect of prevention and treatment of feeding intolerance in STBI patients.Therefore,to promote the early and smooth implementation of enteral nutrition in STBI patients,it is of great significance to clarify the effects of common clinical measures and explore effective prevention strategies on the occurrence of feeding intolerance.This study intends to start with the effect of common clinical measures on enteral nutrition tolerance in STBI patients,and to clarify the protective and risk factors of feeding intolerance in patients with STBI by common clinical nursing measures.In addition,we also try to understand and analyze the current situation of the application of preventive measures of clinical feeding intolerance in China so as to lay a foundation for further exploring effective prevention strategies of feeding intolerance and optimizing clinical prevention programs.Objective:Through retrospective study and cross-sectional investigation,this study intends to analyze the impact of common clinical measures on the occurrence of FI in STBI patients,to clarify the protective factors and risk factors of these measures for FI,to understand the current status of the application of preventive FI measures in China,and to further explore the effective clinical measures for improvement of feeding tolerance of STBI patients.These findings will hopefully provide research evidence to ensure the early and smooth implementation of enteral nutrition.Method:1.A retrospective study on the effect of common treatment and nursing measures on feeding intolerance in patients with severe traumatic brain injuryStudy 1: Effect of common treatment and nursing measures on feeding intolerance in patients with severe traumatic brain injuryThe cluster sampling method was used to collect the medical records of patients with STBI for 6 years through an electronic medical record system and intensive care system.A total of 324 patients with STBI were selected from a comprehensive intensive care unit of a third-class hospital in Chongqing in March 2013.According to the inclusion and exclusion criteria,187 patients who did not meet the criteria were excluded.137 cases were included in this phase of the study.From the date of enteral nutrition to the fifth day as the observation period,the patients were divided into tolerance group and intolerance group according to the occurrence of feeding intolerance during the observation period.15 common medical and nursing measures were analyzed by univariate and multivariate Logistic regression analysis to explore the effects of common clinical measures on the occurrence of feeding intolerance in patients with STBI,and to identify the risk and protective factors.Study 2: Effect of prophylactic use of prokinetic drugs on feeding intolerance in patients with severe traumatic brain injuryAccording to whether or not to use prophylactic prokinetic drugs,which are the protective factors found in the results of the first clinical study during the observation period,137 patients with STBI were divided into two groups.After excluding 20 cases of therapeutic prokinetic drugs during the observation period,the patients with prophylactic use of prokinetic drugs were taken as the prevention group,and the patients without prokinetic drugs were taken as the control group.In order to reduce the influence of clinical measures on the observation index,the patients were matched according to other measures affecting the gastrointestinal function of the patients based on the results of the first clinical study.The incidence of enteral nutrition intolerance was compared between the two groups.The main observation index was the incidence of feeding intolerance,and the secondary observation index was the stool condition and incidence of main clinical FI symptoms such as constipation,diarrhea,gastric retention,abdominal distension,vomiting and so on.2.Cross-sectional investigation on the application of preventive measures of feeding intolerance in patients with severe traumatic brain injuryUsing the method of cross-sectional survey,a self-designed questionnaire was used to investigate the application of national comprehensive ICU/ neurosurgical ICU in the prevention of enteral nutrition intolerance in patients with STBI.The convenient sampling method is used to select the second-level grade-A and above hospitals in China.All questionnaire input,distribution and data collection are completed through the questionnaire star website.The descriptive statistical method was used to analyze the current situation of clinical application of preventive measures.Results:1.A retrospective study on the effect of common treatment and nursing measures on feeding intolerance in patients with severe traumatic brain injury1.1 Incidence of feeding intolerance in patients with STBI: the overall incidence of feeding intolerance was 59.9%,of which the top three gastrointestinal symptoms were constipation(35.4%),diarrhea(24.4%)and gastric retention(17.1%).1.2 Univariate analysis of the influencing factors of feeding intolerance: the use of prokinetic drugs,retention enema,acid suppressants,dehydrating agents and analgesics had significant differences in the occurrence of feeding intolerance(P < 0.05).1.3 Multivariate Logistic regression analysis of influencing factors of feeding intolerance: the use of acid suppressants(OR=4.034,P=0.008,95% CI:1.444-11.268)and analgesics(OR=3.976,P=0.005,95% CI:1.516-10.427)were independent risk factors for the occurrence of feeding intolerance.Prophylactic use of prokinetic drugs(OR=0.202,P=0.000,95% CI:0.089-0.456)was an independent protective factor to reduce the incidence of feeding intolerance.1.4 Compared with the group without prokinetic drugs,prophylactic use of prokinetic drugs could significantly reduce the incidence of feeding intolerance in patients with severe traumatic brain injury(P < 0.05).Specifically,it could effectively reduce the incidence of constipation(P < 0.05),significantly increase the frequency of self-defecation(P < 0.05),but did not increase the incidence of diarrhea(P > 0.05).There was no significant difference in the incidence of gastric retention,abdominal distension and vomiting(P > 0.05).1.5 There was no significant difference in the incidence of feeding intolerance between the combined use of prokinetic drugs and single use of prokinetic drugs in patients with STBI(P > 0.05).2.Cross-sectional investigation on the application of preventive measures for feeding intolerance in patients with severe traumatic brain injury2.1 Questionnaire quality and recovery2.1.1 The content validity of the self-made questionnaire “Application of preventive measures related to enteral nutrition intolerance in patients with Severe traumatic brain injury” was 0.92.2.1.2 A total of 89 second-level grade-A and above hospitals in China were investigated.1109 questionnaires were collected and 996 valid questionnaires were collected,with an effective rate of 89.81%.2.2 Application of preventive measures of feeding intolerance in patients with STBI2.2.1 At the same time,medical staff will use a variety of methods such as scale and patient symptoms to judge the gastrointestinal function of patients with STBI and predict the occurrence of feeding intolerance.2.2.2 Application and management of enteral nutrition in patients with STBI by medical staff.The percentage of patients with initial enteral nutrition at 24-48 hours after injury was 61.45%,the dose of nutrient solution on the first day < 500 ml was 50.00%,the initial type of enteral nutrition was glucose,warm boiled water and other non-nutritious preparations accounted for 65.56%,nasogastric tube intake accounted for 91.16%,continuous infusion of nutrition pump was 72.89%,raising the head of the patient’s bed 30 °-45 °during enteral nutrition accounted for 89.46%,and the residual amount of gastric aspiration by syringe accounted for 93.67%,the gastric residue was monitored every 4 hours,accounting for 51.51%,and the temperature of the nutrient solution reached 65.46% at 38 ℃-40 ℃.2.2.3 The application rates of common clinical measures are as follows: Acid suppressants(84.13%),probiotics(79.01%),enema(73.59%),prokinetic drugs(73.29%).Conclusions:1.There is a high incidence of feeding intolerance in patients with STBI during enteral nutrition,including constipation,diarrhea and gastric retention.2.Common clinical measures can affect the occurrence of feeding intolerance in patients with STBI,in which the prophylactic use of prokinetic drugs is an independent protective factor to reduce the incidence of feeding intolerance,and the applications of acid suppressants and analgesics are independent risk factors.3.Prokinetic drugs can prevent the occurrence of feeding intolerance in patients with STBI,reduce the incidence of constipation and promote the recovery of spontaneous defecation function.4.At present,the common measures taken by domestic clinicians to improve gastrointestinal function and reduce the incidence of feeding intolerance in patients with STBI are as follows: Enteral nutrition began at 24-48 hours after injury,the first day dose < 500 ml,initial administration of glucose,warm boiled water and other non-nutritional preparations,nasogastric tube intake of nutrient solution,continuous pump infusion,bed head raised 30 °-45 °during enteral nutrition,nutrient solution temperature 38 ℃-40 ℃,application of kinetic drugs,enema,probiotics and acid suppressants,etc.