ObjectiveThe quality indexes of enteral feeding nursing process in intensive care unit（ICU）were constructed，and the implementation rate of enteral nutrition quality indexes was monitored to ensure safe and efficient enteral feeding for patients.MethodsUsing the literature review method，the quality index of enteral nutrition nursing process was preliminarily developed through group discussion，and then modified according to the opinions of experts in the letter to construct the best quality index.ResultsThe process indicator system consists of 9 second⁃level items and 29 third⁃level items.In the results of the two rounds of correspondence，the expert positive coefficient was 87%，100%，the opinion submission rate was 55%，50%，the expert authority coefficient was 0.958，0.943，and the Kendall coordination coefficient was 0.089⁃0.237（P<0.05）.ConclusionFocus on the construction of the process index system，further improve the shortcomings，make it scientific and feasible，convenient for clinical application，and improve the quality of enteral feeding of ICU patients.

目的:对重症病人肠内营养中断现状进行调查并探讨中断时间与次数对热卡达标的影响.方法:回顾性收集2022年1月至2022年11月入住南京大学医学院附属金陵医院普通外科ICU实施肠内营养的重症病人,记录病人1周内行肠内营养的相关资料,包括每日实际摄入热卡、肠内营养中断的原因、次数与时间.采用多元线性回归分析肠内营养7 d达标天数的相关因素.结果:共纳入115例重症病人,肠内营养7 d内总中断次数为136次,总中断时间为512.94 h.肠内营养中断发生频率最高的原因是外出检查(33％),其次分别是喂养不耐受(15％)与医生操作(13％);肠内营养中断的持续时间因原因而异,包括手术或术前准备10.20(8.81,18.11)h、喂养不耐受7.33(1.34,21.71)h、气道操作4.30(0.93,10.84)h等.多元线性回归分析显示肠内营养7 d达标天数与中断时间和次数呈负相关(P＜0.05).结论:肠内营养中断常见的原因是外出检查、喂养不耐受、医生操作等,肠内营养中断时间越长、中断次数越多,热卡摄入不足的风险越高.医护人员尽量避免肠内营养中断事件的发生从而改善病人的临床营养结局.

目的 探讨重症急性胰腺炎(SAP)患者腹内压对机械通气相关因素和预后的影响,以及腹内高压的因素影响.方法 回顾性分析 2020 年 1 月-2022 年 7 月东部战区总医院胰腺治疗中心重症监护室行机械通气的SAP患者临床资料,分析机械通气前3 天监测的最高腹内压与当时血流动力情况、呼吸功能监测参数的相关性.根据第1 天是否发生腹内高压分为2 组,比较年龄、性别、病因、BMI、急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)、急性生理与慢性病评分Ⅱ(APACHEⅡ)、通气方式、呼吸机模式、呼吸末正压(PEEP)对腹内高压的影响.结果 收集 174 例机械通气SAP患者,机械通气前 3 天发生腹内高压占比分别为 59.77%、67.24%、68.39%.将腹内压与机械通气相关参数进行相关性分析显示,腹内压与气道峰压(Ppeak)、PaCO2呈正相关(r＞0,P＜0.05),与pH、PaO2/FiO2呈负相关(r＜0,P＜0.05),腹内压与血流动力学之间无相关性(P＞0.05).预测腹内高压的多因素Logistics回归分析显示,BMI(OR=1.174,95%CI:1.059～1.302)、PEEP(OR=1.238,95%CI:1.014～1.511)为SAP患者出现腹内高压的独立危险因素.BMI、PEEP每增加 1 个单位,腹内高压的风险就分别增加 17.4%、23.8%,再根据多因素分析结果作ROC曲线显示,BMI、PEEP预测腹内高压的ROC曲线下面积分别为 0.734(95%CI:0.652～0.816)、0.690(95%CI:0.606～0.775),其预测腹内高压发生的临界值分别为 25.865 kg/m2、6.5 cmH2 O.结论 BMI、PEEP是腹内高压的独立危险因素.腹内高压可直接或间接影响呼吸功能,同时腹内压也随机械通气PEEP值的增加而升高,选择最佳PEEP对平衡腹腔压与肺容积至关重要.

目的:探讨高营养风险机械通气病人肠内营养是否达标与呼吸机拔管的相关性及呼吸机拔管失败的影响因素.方法:回顾性分析普通外科ICU接收的105例重症病人,将病人分为拔管成功组(n=55)和拔管失败组(n=50),比较两组病人喂养达标率、喂养不耐受状况、住院时间及28d死亡率,并分析喂养达标与呼吸机拔管的相关性.结果:两组男性占比居多,拔管成功组为41(74.65％),拔管失败组为39(78.0％),拔管成功组不耐受发生率为19(34.5％),拔管失败组不耐受发生率为18(36.0％).拔管成功组的喂养达标率为33(60.0％),拔管失败组为7(14.0％),P=0.002;拔管成功组住院时间为26.5(13.5,63),拔管失败组为40(27.5,65),P＜0.05;拔管成功组28 d死亡率为3.6％,拔管失败组为20％,P＜0.05.Spearman等级相关分析显示喂养达标与呼吸机拔管成功与否呈负相关(r=-0.421,P＜0.01),当喂养达标率越高时,呼吸机拔管的失败率越低.多因素Logistic回归分析表明,EN不达标是呼吸机拔管失败的独立危险因素.结论:高营养风险机械通气病人呼吸机拔管失败与EN不达标有关,导致病人住院时间延长,28 d死亡率增加.

Aspiration is one of the serious complications of enteral nutrition and is the leading cause of aspiration pneumonia,the occurrence of which increases patient mortality and prolongs hospitalization,affects economic burden of family and society.This paper reviews the research progress of the risk prediction models for aspiration in patients with enteral nutrition support,and introduces the basic situation of the risk prediction model for aspiration in enteral nutrition,the comparative analysis of the prediction models,and the revelation for the future,with the aim of providing a suitable model for the clinical health care personnels to assess and predict the risk of aspiration in patients,and providing a reference basis to realize the early prevention and timely intervention of aspiration

Objective:Analysis of influencing factors of enteral nutrition interruption in critically ill patients in general surgery department and its impact on prognosis.Methods:A total of 91 cases of critically ill patients in general surgery department were selected who were admitted to the general surgery of General Hospital of Eastern Theater Command of the Chinese People′s Liberation Army in Nanjing from June 2021 to March 2022 by convenient sampling method, demographic and enteral nutrition interruption data were collected,and patients were divided into enteral nutrition interruption group and enteral nutrition uninterrupted group to investigate the analysis of the factors of affecting enteral nutrition interruption and its impact on prognosis by Logistic regression analysis.Results:There were 59 cases in the enteral nutrition interruption group and 32 cases in the enteral nutrition uninterrupted group. There were statistically significant differences in gender, analgesic and sedatives, Gastro-kinetic agent and feeding intolerance between both groups ( χ2 values were 4.51-9.97, all P<0.05). Logistic regression analysis results showed that gender ( OR=4.566, 95%CI 1.332-15.657, P<0.05), analgesic and sedatives ( OR=3.437, 95%CI 1.112-10.621, P<0.05), and feeding intolerance ( OR=4.116, 95%CI 1.257-13.479, P<0.05) were the factors of enteral nutrition interruption. There were statistically significant differences between the two groups in the number of days of enteral nutrition up to goal in 3 days, 3-7 days and 7 days, albumin,length of stay in intensive care unit, total length of stay and hospitalization expenses between both groups ( Z values were -2.80 - -0.73, all P<0.05). Conclusions:Female, analgesic and sedatives and feeding intolerance are the risk factors of enteral nutrition interruption in critically ill patients in general surgery department, and enteral nutrition interruption has an adverse impact on the prognosis.Medical staff should avoid excessive use of analgesic and sedatives, and do well in feeding tolerance management to reduce the occurrence of enteral nutrition interruption.