| Objective:To evaluate the present situation of the enteral feeding intolerance(EFI)in the adult patients after cardiopulmonary bypass(CPB),and to explore the influence of EFI on the poor prognosis.To explore the influencing factors of EFI in patients after CPB.Method:A prospective observational study was conducted in a heart medical center in Fujian Province.From March 2020 to June 2020,CPB patients were enrolled according to the inclusion and exclusion criteria.The Intestinal Nutrition Data Collection Table for Patients After Cardiopulmonary Bypassed Surgery was compiled by the authors to collect the baseline characteristics and clinical data.From the beginning of enteral nutrition(EN)to the 7th day of EN,the enteral nutrition implementation of the patients,the symptoms,occurrence time and duration of EFI were assessed and recorded,and the occurrence of poor prognosis during hospitalization was collected.Desptive statistics,t test,Wilcoxon rank sum test,chi-square test or Fisher test,logistic regression analysis models were used for statistical analysis.Pair comparison was performed by Bonferroni method.Results:A total of 393 subjects were included in this study,of which 267 patients developed EFI,with an incidence of 67.9%.(1)In EFI,the incidence of constipation symptoms was the highest,reaching47.1%.The incidence of abdominal distension,diarrhea,vomiting,and a large amount of residual gastric volume symptoms were 24.7%,20.1%,17.8% and 5.1%;52.1% of EFI was 1 item Symptoms,128 EFI patients developed 2 or more symptoms;79.8% of EFI appeared on the 3rd day of EN,and the average time of occurrence was 3.1±1.0days after EN;64.4% of EFI patients had persistent intolerance,and 60.3% of EFI patients had persistent intolerance.95.9% of EFI lasted within 4 days,and recurrent EFI accounted for 6.0% of EFI.(2)The differences in acute kidney injury,prolonged mechanical ventilation,death,stroke and overall poor prognosis between EFI group and non-EFI group were statistically significant(P<0.05).(3)The number of symptoms of EFI was significantly associated with poor prognosis.The incidence of poor prognosis in non-EFI group,EFI symptom number 1～ 2 group and EFI symptom number 3 ～ 5 group were 27.0%,40.8% and 88.6%,respectively.There was statistical difference in the incidence of poor prognosis among all groups and between any two groups(P<0.05).(4)Univariate analysis showed that there were statistically significant differences between the two groups in gender,history of cerebral infarction,operation duration,CPB duration,beginning time of enteral nutrition,Sequential Organ Failure Assessment(SOFA)score,VIS score,hyperglycemia,use of multiple antibiotics,use of drugs regulating intestinal flora and use of sedatives and analgesics(P<0.05).(5)Multivariate unconditional logistic regression analysis showed female(OR=1.679,95%CI=1.038-2.716,P=0.035),SOFA score(OR=1.167,95%CI=1.016-1.340,P=0.029)and hyperglycemia(OR= 1.690,95%CI=1.008-2.833,P=0.047)were the independent risk factor for EFI in patients after CPB.Conclusion:The incidence of EFI was high in patients after CPB,mainly constipation symptoms,which usually occured on the third day of EN.EFI patients tended to have persistent intolerance,and the occurrence of EFI was closely related to the poor prognosis of patients.The greater the number of EFI symptoms,the higher the incidence of poor prognosis,so medical staff should pay more attention to EFI.Female,high SOFA score and postoperative hyperglycemia increase the risk of EFI after CPB.Medical staff should pay attention to the occurrence and development of EFI in female,Severely ill patients and hyperglycemia after CPB. |
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