重症病人接受腸道營養初期發生腸道不適應症之影響因素及因應策略之探討

Factors Predisposing to the Development of Gastrointestinal Intolerances in ICU Patients Starting Enteral Nutrition, and Corresponding Management

邱艷芬(Yann-Fen Chao)

《護理研究》 6卷6期 (1998/12) Pp. 461-474

https://doi.org/10.7081/NR.199812.0461

摘要

本研究以208位住在甲級內外科加護病房、禁食超過 24 小時以上，開始接受腸胃道灌食之成年病患為對象，追蹤其接受腸道營養最初七天之排便性狀、胃殘餘量、以及有與腹脹、腹痛等，以探討影響重症病人接受腸道營養之初期腸道適應情形及其影響因素。自1116筆資料中發現重症病人接受腸道營養的一週內發生胃殘餘量過多、腸音不正常、腹賬、腹瀉的比率分別約為10％、26％、27％、與20％。這些腸道不適應症狀分別與疾病嚴重度、禁食天數、血清白蛋白值、水腫狀態、使用制酸劑、灌食法、灌食速度、灌食液滲透壓有關，而靜脈注射抗生素對此則無明顯相關。APACHE 得分 20 、禁食日3天、白蛋白值2.59/dl、水腫、使用制酸劑為易發生腸道不適應症之良好指標。一次推送與量大之灌食速度促進腸胃蠕動，與腹瀉不一定相關，但病患胃殘餘量過多與腹脹的發生率較低。隨著灌食日數增加，熱量攝取增加，顯示腸道之消化吸收能力隨灌食而進步。在 APACHE大於20、禁食日多於3天、及水腫者，小量慢速度的灌食可減少發生胃殘餘量過多、腸音不正常、與腹脹方面的問題。

關鍵字

腸道營養 ； 胃殘餘量 ； 腹瀉 ； 重症病人

並列摘要

The purpose of this study was to identify factors predisposing to gastrointestinal tolerance in ICU patients during their first 7 days of receiving enteral nutrition. 208 adults admitted to ICUs of two teaching hospitals were included and yielded 1116 observations for data analysis. The result indicated that the severity of illness, days on NPO, serum albumin levels, edema, and the use of antacids have significant influences on the development of gastrointestinal intolerance, as do feeding modality, feeding speed and the osmolarity of feeding formula. APACHE II score of 20, 3 days on NPO, serum albumin level of 2.5g/dl, and edema are good risk indicators for gastrointestinal intolerance. While low speed and continuous feeding accounted for developing excess gastric residual, bolus feeding and increasing feeding speed increased bowel mobility, but did not necessarily result in diarrhea. For patients with APACHE higher than 20, NPO more than 3 days, or who were edematous, low feeding speed of less than 30cc/hr might help to sedate the hyperactive bowel. The caloric intake improved as enteral feeeding continued.

並列關鍵字

enteral nutrition ； gastrointestinal intolerance ； diarrhea ； critically ill patients