南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (7): 1114-1118.doi: 10.12122/j.issn.1673-4254.2021.07.22

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口腔颌面部恶性肿瘤患者肠内营养喂养不耐受状况及影响因素

曾佳琪，张 博，苏红辉   

  • 出版日期:2021-07-20 发布日期:2021-07-16

Incidence of enteral feeding intolerance and its risk factors in patients with oral and maxillofacial malignancies

  • Online:2021-07-20 Published:2021-07-16

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摘要： 目的 探讨口腔颌面部恶性肿瘤患者发生肠内营养（EN）喂养不耐受的状况及其影响因素。方法 对2018年3月~2021年3月入住某三级甲等综合医院实施EN的122例口腔颌面部恶性肿瘤患者病例资料进行回顾性分析，根据患者EN是否耐受分为耐受组（n=70）与不耐受组（n=52），比较两组患者一般资料（年龄、性别、身高、体质量、病理分期）、EN制剂种类、临床治疗（物理降温、鼻饲药物）、药物应用（镇静药、血管活性物、抑酸药、钾制剂、抗生素种类、激素药）、生化指标（血清总蛋白、血清白蛋白、血 糖、血钾浓度）差异，采用Logistic回归分析来分析患者EN喂养不耐受的影响因素。结果 实施EN的122例口腔颌面部恶性肿瘤患者中，喂养不耐受发生率为42.6%。Logistic回归分析显示，使用钾制剂（OR=4.125, P=0.027, 95% CI：1.178~14.444）、使用镇静药（OR=4.125, P=0.000, 95% CI：2.007~11.765）、低蛋白血症（OR=3.557, P=0.010, 95% CI：1.351~9.366）是口腔颌面部恶性肿瘤患者发生EN喂养不耐受的独立危险因素；肠内营养制剂中添加膳食纤维（OR=0.108, P=0.015, 95% CI：0.018~0.643）是其保护性因素。结论 口腔颌面部恶性肿瘤患者EN喂养不耐受发生率较高，建议使用添加膳食纤维的肠内营养制剂，医护人员应密切观察使用钾制剂、镇静药、低蛋白血症患者的EN喂养耐受性情况，及时采取干预措施，降低喂养不耐受发生率。

关键词: 口腔颌面部恶性肿瘤；肠内营养；喂养不耐受；影响因素

Abstract: Objective To explore the incidence of enteral feeding intolerance and its risk factors in patients with malignant oral and maxillofacial tumors. Methods We conducted a retrospective analysis of 122 patients with malignant oral and maxillofacial tumor admitted in a general hospital for enteral nutrition between March, 2018 and March, 2021. The incidence of intolerance to enteral nutrition was analyzed, and the two groups of patients with and without intolerance were compared for age, gender, height, weight, pathological staging, types of enteral nutrition preparations, clinical treatment (physical hypothermia and nasal delivery), drug usage (sedatives, vasoactive drugs, acid suppressant, potassium preparation, antibiotics and hormones) and biochemical parameters (serum total protein, serum albumin, blood glucose and serum potassium concentration). Logistic regression analysis was used to analyze the influencing factors of enteral nutritional feeding intolerance in patients. Results Of the 122 patients, 52 had enteral feeding intolerance with an incidence rate of 42.6%. Logistic regression analysis showed that potassium preparation (OR=4.125, P=0.027, 95%CI: 1.178-14.444), sedatives (OR=4.125, P=0.000, 95%CI: 2.007-11.765) and hypoproteinemia (OR=3.557, P=0.010, 95%CI: 1.351-9.366) were independent risk factors of feeding intolerance in patients with malignant oral and maxillofacial tumors, while adding dietary fiber was a protective factor (OR=0.108, P=0.015, 95%CI: 0.018-0.643). Conclusion The incidence of enteral feeding intolerance is high in patients with malignant oral and maxillofacial tumors. Enteral nutrition preparations with dietary fiber are recommended for these patients. The patients with potassium preparations, sedatives and hypoproteinemia should be closely monitored for enteral feeding intolerance, and timely intervention should be administered to reduce its incidence.

Key words: malignant oral and maxillofacial tumors; feeding intolerance; enteral nutrition; risk factors