Study On The Related Factors Of Diarrhea In Severe Patients With Early Enteral Nutrition And Its Influence On Prognosis

Objective:To investigate the related factors of diarrhea and its influence on prognosis in severe patients with early enteral nutrition.Methods:Clinical information of 95 patients with early enteral nutrition who met the inclusion criteria in the Emergency Intensive Care Unit(EICU)and the Internal Medicine Intensive Care Unit(MICU)of the First Affiliated Hospital of Guangxi Medical University from January 1,2019 to December 31,2019 was retrospectively collected.The data included the patient’s gender,age,history of diabetes,history of hypertension,enteral nutrition type,dose,infusion mode,temperature and nutrient quantity.The patient’s stool status was observed for 48hours after enteral nutrition started.Then kept a record of the patient’s liquid equilibrium state,the WBC,N(×10~9/L),Hb(g/L),lymphocyte absolute value(×10~9/L),K~+(mmol/L),Na~+(moml/L),serum albumin,glycosylated hemoglobin,disease severity score(Apache Ⅱ score,SOFA score),shock or not and related indicators during enteral nutrition.At the same time,the use of antibiotics(course and type),proton pump inhibitors,mechanical ventilation on ventilators and days in ICU and hospitalization expenses were collected.Patients were divided into the diarrhea group and the control group according to whether they had diarrhea,and the survival group and the death group according to the death situation at 28 days.Statistical was using SPSS 22 statistical software,and P<0.05 was considered statistically significant.Results:1.Among the 95 patients in this study,63 in the control group and32 in the diarrhea group,the incidence of early enteral nutritional diarrhea in severe patients was 33.7%.2.In this study,in gender,history of hypertension,the WBC,N,lymphocyte absolute value,Hb,Na~+,albumin,glycosylated hemoglobin,liquid balance,Apache Ⅱ scores,SOFA score,shock,proton pump inhibitors,breathing machine mechanical ventilation,ICU days,hospitalization expenses,enteral nutrition(type,osmotic pressure,infusion method,quantity,and whether contain dietary fiber),antimicrobial agents,etc.,no statistically significant difference were observed in the diarrhea group compared with control group(P>0.05).There were statistically significant differences in age,diabetes history,blood potassium,enteral nutrition temperature(warming/no warming)between the two groups(P<0.05),the average age of the diarrhea group was higher than that of the control group[64.84±16.40 VS 56.68±18.98],the diarrhea rate of the patients with a history of diabetes was higher than that of the patients without a history of diabetes[56.3%VS 29.1%],the serum potassium of the diarrhea group was lower than that of the control group[3.84±0.41 VS 4.13±0.44],and the diarrhea rate of the patients with enteral nutrition heating was higher than that of the patients without enteral nutrition heating[53.8%VS 26.1%].3.Of the 95 cases,46 survived and 49 died,with a mortality rate of51.6%.There was no statistical difference in mortality between diarrhea group and control group(P>0.05).SOFA score of death group was higher than that of survival group[7.00(4.50,11.00)VS 6.00(3.00,8.00)],and the difference was statistically significant(P<0.05).Patients with shock,mechanical ventilation using ventilators,and antifungal medication had a higher mortality rate[66.7%VS 42.4%;58.2%VS 18.8%;63.4%VS 42.6%],and the differences were statistically significant(P<0.05).The two groups were compared in gender,age,history of hypertension,diabetes mellitus,enteral nutrition(temperature,amount,whether contain dietary fiber),the WBC,N,Hb,lymphocyte absolute value,K~+,Na~+,albumin,glycosylated hemoglobin,liquid balance,Apache Ⅱ score and proton pump inhibitors,antibacterial drugs(penicillium species number,course,carbon alkene,beta lactam,quinolone and aminoglycoside,pbo alkane ketone,sugar peptide,antiviral drugs),etc.The results showed that the differences were not statistically significant(P>0.05).4.Logistic multivariate regression analysis results showed that diabetes history,enteral nutrition temperature(warming/no warming)and serum potassium were independent risk factors for early enteral nutrition diarrhea in severe patients(P=0.016,OR=0.200,95%CI:0.054,0.741).P=0.024,OR=3.368,95%CI:1.175,9.660;P=0.003,OR=0.141,95%CI:0.039,0.506).Ventilator mechanical ventilation was an independent risk factor for death in patients with severe enteral nutrition in early stage(P=0.045,OR=4.402,95%CI:1.036,18.698).Conclusion:1.In this study,the rate of early enteral nutritional diarrhea in severe patients was 33.7%.The incidence of diarrhea is high.2.In this study,diabetes history,enteral nutrition temperature(warming/no warming),and blood potassium were independent risk factors for early enteral nutrition diarrhea in severe patients.Mechanical ventilation is an independent risk factor for death in patients with severe enteral nutrition in early stage.