NICU无创呼吸机通气患儿肠内营养喂养不耐受的影响因素分析

doi:10.3761/j.issn.2096-7446.2025.10.006

摘要/Abstract

摘要：

目的调查新生儿重症监护病房（neonatal intensive care unit，NICU）无创呼吸机通气患儿肠内营养喂养不耐受（feeding intolerance，FI）发生状况，分析FI的影响因素，为预防FI提供参考依据。方法收集2022年1月—2024年3月乌鲁木齐某三级甲等医院NICU的172例接受无创呼吸机通气患儿作为研究对象，回顾性分析临床资料，观察FI发生率。根据是否发生FI，分为FI组和非FI组，采用Logistic回归分析FI影响因素，绘制受试者工作曲线（receiver operating characteristic，ROC）评价Logistic回归模型对FI的预测价值。结果 172例患儿中，64例（37.2%）发生FI。FI组早产儿比例、新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome，NRDS）比例、急性生理与慢性健康Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ，APACHE Ⅱ）评分、开始首次肠内营养时间、经鼻间歇正压通气比例、腹内压和使用镇静药物比例高于非FI组（P<0.05）。Logistic回归显示，早产儿（OR=5.516）、NRDS（OR=4.242）、APACHE Ⅱ评分（OR=1.797）、开始首次肠内营养时间（OR=1.163）、经鼻间歇正压通气（OR=4.029）、腹内压（OR=2.017）和使用镇静药物（OR=4.247）均是NICU接受无创呼吸机通气患儿FI的独立危险因素（P<0.05）。ROC分析显示，Logistic回归模型预测FI的曲线下面积为0.974，灵敏度为96.9%，特异度为91.7%，预测效果良好。结论 NICU接受无创呼吸机通气患儿具有较高的肠内营养FI发生率，早产儿、NRDS、APACHE Ⅱ评分、开始首次肠内营养时间、经鼻间歇正压通气、腹内压和使用镇静药物是其危险因素。对于存在上述FI危险因素的患儿，应及早干预并尽早开始肠内营养支持，选择合适的通气模式，尽量避免或减少镇静药物的使用。

关键词: 新生儿重症监护病房, 无创呼吸机通气, 肠内营养, 喂养不耐受, 风险因素, 危重症护理

Abstract:

Objective To investigate incidence of enteral nutrition feeding intolerance（FI） in pediatric patients receiving non-invasive ventilation in the neonatal intensive care unit（NICU） and analyze influencing factors for FI，for providing reference for preventing FI. Methods 172 pediatric patients receiving non-invasive ventilation in NICU in a class A tertiary hospital in Urumqi from January 2022 to March 2024 were collected as research subjects. Clinical data of the research subjects were investigated through medical record system and their clinical data were retrospectively analyzed. Incidence of FI was observed. Those pediatric patients were divided into FI group and non-FI group based on whether FI occurred and clinical data were compared between the two groups. Logistic regression was used to analyze influencing factors of FI. Receiver operating curve（ROC） was drawn to evaluate prediction value of Logistic regression model for FI. Results Among 172 pediatric patients，37.2% experienced FI. The proportion of premature infants，proportion of neonatal respiratory distress syndrome（NRDS），Acute Physiological and Chronic Health Ⅱ（APACHE Ⅱ） score，time to first enteral nutrition，nasal intermittent positive pressure ventilation，intra-abdominal pressure and proportion of use of sedatives in the FI group were higher than those in the non-FI group（P<0.05）. Logistic regression showed that premature infants（OR=5.516），NRDS（OR=4.242），APACHE Ⅱ score（OR=1.797），time to first enteral nutrition（OR=1.163），nasal intermittent positive pressure ventilation（OR=4.029），intra-abdominal pressure（OR=2.017） and use of sedatives（OR=4.247） were all independent risk factors for FI in NICU patients receiving non-invasive ventilation（P<0.05）. ROC analysis showed that the area under the curve（AUC） of the Logistic regression model was 0.974，with a sensitivity of 96.9% and a specificity of 91.7%，indicating good predictive performance. Conclusion Pediatric patients receiving non-invasive ventilation in NICU have a high incidence of enteral nutrition FI. Premature infants，NRDS，APACHE Ⅱ score，first enteral nutrition，nasal intermittent positive pressure ventilation，intra-abdominal pressure and use of sedatives are risk factors for FI. For pediatric patients with the above-mentioned FI risk factors，they should be intervened early. And we should start enteral nutrition support as early as possible，choose an appropriate ventilation mode and try to avoid and reduce the use of sedatives.

Key words: Neonatal Intensive Care Unit, Non-Invasive Ventilator Ventilation, Enteral Nutrition, Feeding Intolerance, Risk Factors, Critical Care Nursing

王妍, 张慧, 唐春, 巴依尔才次克. NICU无创呼吸机通气患儿肠内营养喂养不耐受的影响因素分析[J]. 中华急危重症护理杂志, 2025, 6(10): 1189-1194.

WANG Yan, ZHANG Hui, TANG Chun, BA Yiercaicike. Analysis on influencing factors of enteral nutrition feeding intolerance in pediatric patients receiving non-invasive ventilation in NICU[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(10): 1189-1194.

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