Correlation Between Neurological Critical Illness And Gastrointestinal Dysfunction

Objective: To analyze the status of gastrointestinal dysfunction,related risk factors and prognosis in neurological critically ill patients..Methods: A total of 274 patients were enrolled in the Department of Neurology Intensive Care Unit of the 940 th Hospital of the People’s Liberation Army Joint Service Support Force,from january 2018 to january 2019.On the 1st,4th,7th,15 th,and 28 th day after the NICU,the patients were diagnosed and graded by AGI,and the clinical data of the patients were recorded,including general information,past history,comorbidities,serological indicators and rating scales,and the outcome of the condition.Gastrointestinal dysfunction was never recorded during NICU stay as a group without gastrointestinal dysfunction,and as long as a gastrointestinal dysfunction occurred once,it was recorded as a gastrointestinal dysfunction group.To compare the general admission data of the two groups of patients,to analyze the factors that may affect gastrointestinal dysfunction by univariate and multivariate analysis,to find the risk factors for gastrointestinal dysfunction,and to compare the NIHSS scores and serological indicators when patients with cerebrovascular disease were discharged.Whether there is a difference,explore the factors of poor prognosis.Data were statistically processed using SPSS 25.0 software,chi-square test was used for comparison of count data,logistic regression analysis was used for multivariate analysis,t-test was used for measurement data,and mean ± standard deviation(x±s)was used for non-normal distribution.The measurement data was tested by rank sum test,P<0.05 was statistically significant.Results: 1.274 cases of NICU hospitalized patients,aged 13 to 90 years,mean(57.97±19.03)years old,182 males(66.42%),92 females(33.58%),212 cases of gastrointestinal dysfunction,the overall incidence was 77.37%.2.In the whole group of NICU patients,the length of hospital stay,duration of stay of NICU,hospitalization The incidence of pulmonary infection,liver dysfunction,treatment,nutritional methods,nutritional days,mechanical ventilation,and NIHSS and GCS scores at admission were statistically significant(P<0.05).Serological indicators of patients admitted to hospital,the results showed that LDH,prealbumin,retinol binding protein were P <0.05,thedifference was statistically significant.3.Binary logistic analysis was used to investigate the risk factors associated with gastrointestinal dysfunction.The results showed that NICU stayed and GCS score at admission is an independent risk factor for gastrointestinal dysfunction.4.Serum albumin,prealbumin,retinol-binding protein and neutrophils were all decreased at hospital admission,and the difference was significant(P<0.05).Baseline serum prealbumin,albumin and prealbumin at discharge were lower in the enteral nutrition group than in the self-feeding group,and the difference was significant(P<0.05).The leucocyte and neutrophil levels at baseline and discharge in enteral nutrition group were higher than those in self-feeding group,and the difference was statistically significant(P<0.05).5.Gastrointestinal dysfunction occurred in 138 of 181 patients with cerebrovascular disease,with an overall incidence of 76.24%.The incidence of gastrointestinal dysfunction in the subcerebral hemorrhage group was 90%,and the incidence of gastrointestinal dysfunction in the subcerebral infarction group was 72.3%.The highest grade distribution of AGI during hospitalization was 44 cases of grade 0,101 of grade I,31 of grade II,3 of grade III,and grade IV.2 cases,accounting for 24.31%,55.80%,17.13%,1.66%,1.10%,respectively,in patients with different AGI grades in diagnosis,pulmonary infection,heart failure,liver dysfunction,renal insufficiency,received treatment.There were significant differences in the severity of surgical methods,mechanical ventilation,shock,distant organ dysfunction,and nutritional methods(P<0.05).6.Patients with cerebral hemorrhage and cerebral infarction peaked in the gastrointestinal dysfunction on the fourth day of the disease course;The AGI score on the 7th and 15 th day and the highest AGI in the hospital during the two groups.The scores were statistically significant(P<0.05).7.Patients with cerebrovascular disease in the gastrointestinal dysfunction group and the non-gastrointestinal dysfunction group,age,duration of NICU stay,length of hospital stay,number of days of nutrition,NIHSS score at admission(NIHSS1),The APACHE II score,GCS score,and pre-albumin comparison at admission were statistically significant(P < 0.05).8.Univariate regression analysis of risk factors for patients with cerebrovascular disease ofdifferent AGI grades,results showed that age,length of stay of NICU,length of hospital stay,length of hospital stay,diagnosis,treatment received,comorbidities(lung Infection,heart failure,liver dysfunction,renal insufficiency,arrhythmia,mechanical ventilation,shock,distant organ dysfunction),nutritional mode,number of days of nutrition,NIHSS score at admission(NIHSS1),serological markers at admission(blood LDH,lactic acid,albumin,prealbumin,white blood cell count,neutrophil count).There were significant correlations which were ststistically significant(P<0.05).9.Multivariate ordered logistic regression analysis was performed on the risk factors of patients with different AGI grade cerebrovascular diseases.The results showed that NICU stayed and pulmonary infection,heart failure,nutritional mode is the severity of gastrointestinal dysfunction in patients with cerebrovascular disease Independent influence factors.10.The higher the NIHS score of patients with cranial vascular disease at admission and discharge,the higher the AGI grade,and the difference in NIHSS scores between patients with different gastrointestinal dysfunction severity was statistically significant(P<0.05).Conclusions:1.Patients with neurological intensive care have a higher proportion of gastrointestinal dysfunction,which is worthy of clinical attention.2.The severity of the primary disease,the degree of neurological deficit,and the presence or absence of comorbidities are independent risk factors for gastrointestinal dysfunction in critically ill patients;the occurrence of gastrointestinal dysfunction is not conducive to the recovery of neurological function.3.Active prevention and treatment of complications and early administration of enteral nutrition can reduce the incidence and reduce the incidence of gastrointestinal dysfunction to some extent.