Early Gastrointestinal Dynamic Changes And Related Factors In Severe Neurologic Patients

Background:Nutritional disorders can be caused by acute stress,disturbance of consciousness and swallowing function and high intracranial pressure in severe neurological patients after injury.Nutritional status is closely related to the clinical prognosis of patients.Malnutrition can increase complications,prolong the time of ventilator withdrawal,prolong hospitalization time and increase mortality.EN intervention can effectively improve the clinical outcomes of patients.Effective nutritional measures depend on accurate and timely assessment of gastrointestinal status.GMD is a common complication in severe neurological patients,which mainly manifests as diarrhea,vomiting,abdominal distension,constipation,delayed gastric emptying,etc.Early monitoring of gastrointestinal function and implementation of nutritional treatment are of great significance to the prognosis of patients.Monitoring the MI of gastrointestinal motility in patients with severe neurological diseases by ultrasound can indirectly reflect the status of gastrointestinal motility.The purpose of this study is to monitor the early gastrointestinal motility changes of patients with severe neurological disorders after admission by using ultrasound technology,and to analyze the relevant factors affecting the gastrointestinal motility changes,so as to provide scientific basis for the effective implementation of nutritional support for such patients.Objective:To explore the changes of gastrointestinal motility in patients with severe neurosis after injury;to explore the related factors affecting the gastrointestinal motility of patients with severe neurological diseaseObjective:To explore the changes of gastrointestinal motility in patients with severe neurosis after injury;To explore the related factors affecting the gastrointestinal motility of patients with severe neurological disease.Method:This study is a descriptive study,using convenience sampling method to investigate and study 118 cases of patients with severe neurological diseases admitted to a third-level first-class hospital in SuZhou from January 2018 to March 2019.MI values of patients in the Neurosurgery Intensive Care Unit(NICU)at different time points after admission were monitored by bedside ultrasound.Patients were recorded and observed for early drug treatment and related adjuvant treatment after admission,and clinical symptoms of gastrointestinal tract were evaluated daily.Repeated measurement analysis was used to analyze the changes in patients' early gastrointestinal motility after admission,and one-way anova,correlation analysis,multiple linear regression analysis and other methods were used to analyze the relevant factors affecting the changes in patients' early gastrointestinal motility after admission.Results:The MI curve of 118 patients with severe neurologic disease fluctuated after admission.By observing the MI curve,it was found that the MI value was measured as early as 6h after admission,with an average value of 0.398±0.151.After admission,48hMI was the lowest,with an average value of 0.300±0.109.After admission,66hMI was the highest,with an average value of 0.869±0.294.By comparing the MI values before and after EN,it was found that the MI values after EN were significantly higher than those before EN(p<0.05).Through correlation and multiple linear regression analysis found that:APACHE II score with patients admitted to hospital after 48hMI value has strong positive correlation(r=0.542,p<0.05),the slope value of 0.019;There was a strong positive correlation between GCS and 48hMI after admission(r=0.696,p<0.05),and the slope value was 0.013.There was a moderate negative correlation between BMI and 48hMI after admission(r=-0.405,p<0.05),and the slope value was-0.013.The predictive values of 48hMI using Mechanical Ventilation(MV),gender,smoking or drinking history have influences on the predictive values of 48hMI after admission(p<0.05).The slope values are 0.001,-0.003,0.101,0.026,respectively.The duration of surgery had an effect on the vomiting of the patient 48h after injury(p<0.05),and the slope value was-0.003.The type of disease and the use of antibiotics had an impact on the occurrence of diarrhea 48 hours after admission(p<0.05),with slope values of-0.013 and 0.212,respectively.BMI value and the type of nutrient solution infusion had an effect on post-injury constipation(p<0.05),and the slope values were-0.013 and 0.031,respectively.GCS,the use of vasoactive drugs,hormones and ice blankets had an effect on the occurrence of GRV after admission(p<0.05),with slope values of 0.086,-0.009,0.815 and 0.148,respectively.GRV had a significant effect on 48hMI after admission(p<0.05),and the slope value was 0.131.Conclusion:The MI curve of severe neurological patients in the early post-injury period showed fluctuation;the MI value was measured at the earliest 6 hours after admission;the MI value was the lowest at 48 hours and the highest at 66 hours;EN had an effect on gastrointestinal motility of severe neurological patients;the factors affecting gastrointestinal motility of severe neurological patients were APACHE II,GCS,gender,BMI,smoking,drinking,type of nutritional infusion,experience of surgery and operation duration.Time,use of vasoactive drugs,use of hormone drugs,MV,use of ice blanket,type of disease.