CAJ | 학술논문

目的：了解重症神经疾病患者在肠内营养过程中胃肠动力不全的发生率，并探讨其影响因素。方法于2010年1月—2013年12月，选取在首都医科大学宣武医院神经内科重症监护病房（ neuro -intensive care unit， NICU）接受治疗的肠内营养患者883例。按胃肠动力情况，将其分为胃肠动力正常组和胃肠动力不全组。回顾性分析2组患者的临床资料，探讨其发生胃肠动力不全的影响因素。结果883例患者中胃肠动力不全的发生率为25.7%（227/883）。入住NICU患者数较多的前8种疾病中，吉兰-巴雷综合征、抗N-甲基-D-天冬氨酸受体脑炎及癫痫持续状态患者胃肠动力不全的发生率较高，分别为47.1%（16/34）、41.7%（5/12）及38.5%（5/13）。单因素分析显示，2组患者高血糖、低钾血症、使用镇静药及机械通气比较，差异有统计学意义（ P﹤0.05）；糖尿病病史、低蛋白血症、癫痫发作比较，差异无统计学意义（ P﹥0.05）。多因素Logistic回归分析显示，高血糖和使用镇静药对重症神经疾病患者肠内营养发生胃肠动力不全的影响有统计学意义（ P﹤0.05）。结论重症神经疾病患者在肠内营养过程中胃肠动力不全的发生率较高，当患者出现高血糖、低钾血症、使用镇静药及机械通气情况时，临床医生应高度重视，及时给予患者有效干预和治疗，预防胃肠动力不全的发生。
목적：료해중증신경질병환자재장내영양과정중위장동력불전적발생솔，병탐토기영향인소。방법우2010년1월—2013년12월，선취재수도의과대학선무의원신경내과중증감호병방（ neuro -intensive care unit， NICU）접수치료적장내영양환자883례。안위장동력정황，장기분위위장동력정상조화위장동력불전조。회고성분석2조환자적림상자료，탐토기발생위장동력불전적영향인소。결과883례환자중위장동력불전적발생솔위25.7%（227/883）。입주NICU환자수교다적전8충질병중，길란-파뢰종합정、항N-갑기-D-천동안산수체뇌염급전간지속상태환자위장동력불전적발생솔교고，분별위47.1%（16/34）、41.7%（5/12）급38.5%（5/13）。단인소분석현시，2조환자고혈당、저갑혈증、사용진정약급궤계통기비교，차이유통계학의의（ P﹤0.05）；당뇨병병사、저단백혈증、전간발작비교，차이무통계학의의（ P﹥0.05）。다인소Logistic회귀분석현시，고혈당화사용진정약대중증신경질병환자장내영양발생위장동력불전적영향유통계학의의（ P﹤0.05）。결론중증신경질병환자재장내영양과정중위장동력불전적발생솔교고，당환자출현고혈당、저갑혈증、사용진정약급궤계통기정황시，림상의생응고도중시，급시급여환자유효간예화치료，예방위장동력불전적발생。
Objective To investigate the incidence of gastrointestinal dysmotility in patients with severe neurological diseases amid enteral nutrition and its risk factors. Methods We selected 883 patients who received enteral nutrition in neuro-intensive care unit ( NICU ) of Xuanwu Hospital of Capital Medical University from January, 2010 to December, 2013. According to the condition of gastrointestinal motility, the patients were divided into two groups including normal gastrointestinal motility group and gastrointestinal dysmotility group. Clinical data of the two groups were analyzed retrospectively to investigate the influencing factors for gastrointestinal dysmotility. Results The incidence of gastrointestinal dysmotility was 25. 7%(227/883). Among the 8 diseases with which more patients admitted into NICU were diagnosed with,Guillain-Barre syndrome,anti - N - Methyl - D - aspartate receptor encephalitis, and status epilepticus led to higher incidence of gastrointestinal dysmotility,respectively 47. 1%(16/34),41. 7%(5/12)and 38. 5%(5/13). Univariate logistic analysis showed the comparison of hyperglycaemia, hypokalemia, sedative administration and mechanical ventilation between the two groups had statistical significance ( P ﹤0. 05 );the comparison of diabetes mellitus history, hypoproteinemia, and epileptic seizure had no significance ( P ﹥ 0. 05 ) . Multivariate logistic regression analysis showed hyperglycaemia and sedatives administration had significant influence on the incidence of gastrointestinal dysmotility in patients with severe neurological diseases amid enteral nutrition(P﹤0. 05). Conclusion The incidence of gastrointestinal dysmotility in patients with severe neurological diseases is higher than those without it. We suggest that clinicians pay special attention when hyperglycaemia, hypokalemia, sedative administration and mechanical ventilation occur and offer timely and effective intervention and treatment to prevent gastrointestinal dysmotility.