| Objective(s):To explore the influence of enteral nutrition tolerance assessment and graded management on enteral nutrition tolerance,nutritional status and clinical outcome of critically ill patients in ICU.Methods:Eighty-eight critically ill patients admitted to ICU of a third-class hospital in Yunnan province from March 2021 to March 2022 were selected as the research objects,and the unequal control group design method was adopted.Forty-two patients from March 2021 to September 2021 were taken as the control group,and 46 patients from September 2021 to March 2022 were taken as the experimental group.Both groups were at risk of malnutrition,and they started enteral nutrition with stable hemodynamics and no contraindications to enteral nutrition after being admitted to ICU.Both groups followed the principle of energy supplement for critically ill patients,and started and implemented EN according to the enteral nutrition feeding process for critically ill patients.Routine EN nursing program was implemented in the control group,and EN tolerance in the experimental group was evaluated every 6hours by enteral nutrition tolerance evaluation form after EN was started(including nausea and vomiting,reflux and aspiration,abdominal distension,abdominal pain,diarrhea,bowel sounds and hemodynamics,with each score of 0-9,the higher the score,the more severe the symptoms).According to the tolerance evaluation score,the speed and amount of EN were adjusted until the target feeding amount and feeding target were reached.For the main symptoms of feeding intolerance-gastrointestinal symptoms,use the gastrointestinal intolerance grading and management table to grade the intolerance symptoms and take corresponding nursing management measures.The tolerance indexes of two groups patients were recorded by enteral nutrition tolerance observation table,and the nutritional indexes and clinical indexes of two groups of patients were collected by electronic medical record system.The incidence of feeding intolerance and symptoms of non-feeding intolerance after enteral nutrition for one week were compared between the two groups.The changes of nutritional indexes(serum albumin,prealbumin)in the two groups were compared at the beginning of EN,the third day of EN and the seventh day of EN.Compare the times of EN suspension in one week between the two groups;the difference of target feeding time and clinical outcome indexes(ICU stay time,mechanical ventilation time,28-day mortality)between the two groups was compared.Results:1 Baseline dataComparing the general data of the two groups,such as age,sex,height,weight,acute physiological and chronic health scores,nutritional risk screening scores,basic disease types,enteral nutrition tube feeding ways and methods,there was no statistical difference(P>0.05).2 Tolerance indicators2.1 Feeding intoleranceComparing the FI status of the two groups in the first week of EN,there were 30patients with FI in the control group,and the incidence rate was higher than that of 22patients in the experimental group,the difference was statistically significant(χ~2=4.209,P<0.05).The incidence of diarrhea and abdominal distension in the control group was higher than that in the control group,and the difference was statistically significant(χ~2=4.058,4.745,P<0.05).There was no significant difference in the incidence of vomiting and abdominal pain between the control group and the experimental group(χ~2=0.668,1.333,0.000,P>0.05).No reflux and aspiration occurred in both groups within 7 days after enteral nutrition.2.2 Feeding standard timeThe time of reaching the standard of enteral nutrition target feeding amount in the experimental group was shorter than that in the control group,and the difference was statistically significant(Z=-5.356,P<0.05).2.3 Pause times of enteral nutritionThe number of times of stopping enteral nutrition within 7 days after the start of enteral nutrition among groups was compared.The total number of times of stopping enteral nutrition in the control group was 28 times due to gastrointestinal intolerance within 7 days,and the total number of times of stopping enteral nutrition in the experimental group was 9 times due to gastrointestinal intolerance within 7 days.The number of times of stopping enteral nutrition in the experimental group was significantly lower than that in the control group,and the difference was statistically significant(Z=-4.917,P<0.05).3 Nutritional indicators3.1 Comparison between groups of basic nutritional indicatorsThere was no significant difference in body mass index between the two groups before enteral nutrition(t=-0.908,P>0.05).There was no significant difference in serum albumin and prealbumin between the two groups when they entered ICU(t=-0.219,0.322,P>0.05).There was no significant difference in serum albumin and prealbumin between the two groups on the first day of enteral nutrition(Z=-0.286,-0.146,P>0.05).3.2 Comparison of the third day enteral nutrition indexes between groupsThere was no significant difference in serum albumin and prealbumin between the two groups on the third day of enteral nutrition(Z=-1.129,t=-0.645,P>0.05).3.3 Comparison of the seventh day enteral nutrition indexes between groupsThe albumin and prealbumin in the experimental group were higher than those in the control group on the seventh day of enteral nutrition,and the difference was statistically significant(Z=-3.938,t=-2.948,P<0.05).3.4 Intra-group comparison of nutritional indexes after enteral nutrition for one weekAfter one week of enteral nutrition,the serum albumin of patients in two groups increased on the seventh day after enteral nutrition,and the difference was statistically significant(t=-2.882,-4.425,P<0.05).Compared with the patients in ICU,the prealbumin in the experimental group increased on the seventh day of enteral nutrition,and the difference was statistically significant(t=-3.628,P<0.05),while the albumin in the control group did not increase significantly before the seventh day of EN,and the difference was not statistically significant(t=-1.311,P>0.05).4 Clinical outcome indicatorsAfter one week of enteral nutrition,the hospitalization time and mechanical ventilation time in ICU of the control group were longer than those of the experimental group,with statistical significance(Z=-7.954,-7.898,P<0.05);Compared with the control group,the 28-day mortality of the experimental group had no significant difference(χ~2=0.000,P>0.05).Conclusion(s):The enteral nutrition tolerance evaluation table is used to actively evaluate the enteral nutrition intolerance of critical patients in ICU,and the grading and management table of gastrointestinal intolerance is used for grading nursing management,which can reduce the incidence of feeding intolerance of critical patients in ICU,reduce the number of enteral nutrition pauses,and shorten the target feeding time,thus ensuring the early successful implementation of enteral nutrition,effectively improving the nutritional status of critical patients,shortening the hospitalization time and mechanical ventilation time of patients in ICU.It has important clinical significance for the evaluation and nursing management of feeding intolerance of critical patients during enteral nutrition treatment. |
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