【摘要】 目的 探讨急性胃肠功能损伤（AGI）分级指导下脓毒症患者早期肠内营养（EN）的效果及对近期预后的影响。方法 回顾性选择2014年3至8月浙江省14个成人综合ICU收治的脓毒症患者102例，按照入院后1周内最差的AGI分级分为4组：无AGI组、AGIⅠ级组、AGIⅡ级组、AGIⅢ+Ⅳ级组。比较各组入院时急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）评分、序贯器官衰竭评估（SOFA）评分、平均动脉压（MAP）等基本资料及住院28 d生存率、无机械通气时间、抗生素使用时间、入院7 d内EN达标比例等指标。采用Kaplan-Meier生存曲线和log-rank检验评估不同AGI分级脓毒症患者生存率的差异，采用Cox回归分析脓毒症患者生存预后的独立影响因素。结果 4组患者APACHEⅡ评分、SOFA评分、MAP、乳酸、无机械通气时间及抗生素使用时间比较，差异均有统计学意义（均P<0.05）。存在AGI的患者住院28 d生存率低于无AGI患者，且AGI分级越高，生存率呈下降趋势，差异均有统计学意义（均P<0.05）。入院第3天EN 80%达标、第7天EN达标的患者住院28 d生存率高于未达标组，差异均有统计学意义（均P<0.05）。Cox回归分析发现乳酸（HR=1.180,95%CI:1.045～1.340,P=0.008）、AGI分级（HR=1.304,95%CI:1.041～1.567,P=0.012）、APACHEⅡ评分（HR=1.069,95%CI:1.013～1.129,P=0.015）和SOFA评分（HR=1.183,95%CI:1.040～1.330,P=0.005）是导致脓毒症患者死亡的独立危险因素，而MAP(HR=0.969,95%CI:0.949～0.989,P=0.003)和入院第7天EN达标（HR=0.458,95%CI:0.225～0.930,P=0.031）则是保护性因素。结论 基于AGI分级标准来指导脓毒症患者的早期EN具有一定的临床适用性。同时，AGI分级越高预示死亡率越高，而EN早期达标则可降低脓毒症患者的死亡率。更多还原

【Abstract】 Objective Investigate the effect of early enteral nutrition(EN) guided by acute gastrointestinal injury(AGI grading on septic patients and its impact on short-term prognosis. Methods A retrospective analysis was conducted on102 septic patients admitted to 14 comprehensive ICUs from March 2014 to August 2014 in Zhejiang. Participants were categorized into four groups based on their highest AGI grade during the first week of admission: non-AGI group, AGI gradeⅠ group, AGI gradeⅡ group, and AGI gradeⅢ+Ⅳ group. Baseline data, including Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ) Score, Sequential Organ Failure Assessment(SOFA) Score, and mean arterial pressure(MAP), as well as other indicators such as the 28-day hospital survival rate, duration of mechanical ventilation-free days, duration of antibiotic use, and the proportion of patients achieving EN caloric targets within 7 days of admission were compared among the groups. Survival rates among septic patients with different AGI grades were assessed using Kaplan-Meier survival curves and log-rank tests. Independent influence factors for survival prognosis in septic patients were identified using a Cox proportional hazards regression model. Results Significant differences were observed in APACHEⅡ Score, SOFA Score,MAP, lactic acid, duration of mechanical ventilation-free days, and duration of antibiotic use among the four groups(all P<0.05). Patients with AGI had a lower 28-day hospital survival rate than those without AGI, and survival rates decreased with increasing AGI grades, with significant differences(all P<0.05). Patients who met EN caloric targets on the 3rd and 7th days after admission had significantly higher 28-day hospital survival rates than those who did not, with significant differences(P<0.05). Cox regression analysis identified lactate levels(HR=1.180, 95%CI: 1.045-1.340, P=0.008), AGI grading(HR=1.304,95%CI: 1.041-1.567, P=0.012), APACHEⅡ Score(HR=1.069, 95%CI: 1.013-1.129, P=0.015), and SOFA Score(HR=1.183,95%CI: 1.040-1.330, P=0.005) as independent risk factors for mortality in septic patients, whereas MAP(HR=0.969, 95%CI:0.949-0.989, P=0.003) and achieving EN caloric targets by the 7th day of admission(HR=0.458, 95%CI: 0.225-0.930, P=0.031) were identified as protective factors. Conclusion Early enteral nutrition in septic patients based on AGI grading has certain clinical significance. Higher AGI grades are predictors of increased mortality rates, whereas early achievement of target EN caloric intake reduces mortality in septic patients.更多还原