危重患者急性胃肠损伤影响因素的Meta分析

doi:10.3761/j.issn.2096-7446.2025.11.016

摘要/Abstract

摘要：

目的系统评价危重患者发生急性胃肠损伤（acute gastrointestinal injury，AGI）的影响因素。方法系统检索PubMed、Web of Science、Cochrane Library、中国知网、万方数据库、维普中文科技期刊数据库及中国生物医学文献数据库中关于危重患者发生AGI的影响因素相关文献，检索时限为建库至2024年3月12日。由2名独立研究者进行文献筛选、数据提取及质量评价，使用R软件（4.3.3版本）进行Meta分析。结果共纳入17篇文献，研究对象共187 686例，涉及47个影响因素。Meta分析结果显示：空腹血糖[比值比（odds ratio，OR）=154.28，95%CI=21.79~1 092.42，P<0.01]、降钙素原（OR=26.82，95%CI=1.26~568.82，P=0.03）、D-乳酸（OR=3.33，95%CI=1.87~5.96，P<0.01）、血乳酸（OR=1.41， 95%CI=1.15~1.73，P<0.01）、胰岛素抵抗指数（OR=81.74，95%CI=12.26~545.14，P<0.01）、腹腔内压（OR=3.03，95%CI=1.31~7.03，P<0.01）、多器官功能障碍综合征（OR=5.26，95%CI=1.65~16.69，P<0.01）、心力衰竭（OR=2.93，95%CI=1.53~5.60， P<0.01）、低血压（OR=5.24，95%CI=1.94~14.13，P<0.01）、使用机械通气（OR=3.52，95%CI=2.19~5.67，P<0.01）、入住ICU时间（OR=1.64，95%CI=1.14~2.35，P<0.01）、急性生理学及慢性健康状况评分Ⅱ（OR=1.11，95%CI=1.00~1.23，P<0.05）、序贯器官衰竭评分（OR=1.12，95%CI=1.03~1.21，P<0.01）是危重患者发生AGI的危险因素，胃窦运动指数（OR=0.33， 95%CI=0.17~0.62，P<0.01）是保护因素。结论危重症患者发生AGI的影响因素众多，临床医护工作者应尽早识别相关影响因素，并采取针对性的预防和治疗措施，以降低AGI的发生率和相关并发症，从而改善危重患者的临床预后。

关键词: 危重患者, 急性胃肠损伤, 影响因素, Meta分析, 循证护理学

Abstract:

Objective To systematically review the influencing factors for acute gastrointestinal injury（AGI） occurrence in critically ill patients. Methods PubMed，Web of Science，Cochrane Library，CNKI，Wanfang Data，VIP，and CBM were searched for studies related to influencing factors of AGI occurrence in critically ill patients from inception to March 12，2 024.Two researchers independently screened literature，extracted data，and assessed the quality of included studies. Meta-analysis was performed using R software（version 4.3.3）. Results A total of 17 literatures were included，with a total of 187 686 subjects，involving 47 influencing factors. Meta-analysis showed that fast plasma glucose （OR = 154.28， 95%CI = 21.79-1 092.42， P < 0.01），procalcitonin （OR = 26.82， 95%CI = 1.26-568.82， P = 0.03），D-lactate （OR = 3.33，95%CI = 1.87-5.96，P < 0.01），lactic acid （OR = 1.41， 95%CI=1.15-1.73， P < 0.01），insulin resistance index （OR = 81.74， 95%CI = 12.26-545.14， P < 0.01），intra-abdominal pressure （OR=3.03，95%CI = 1.31-7.03，P < 0.01）， multiple organ dysfunction syndrome （OR = 5.26，95%CI = 1.65-16.69，P < 0.01）， heart failure （OR = 2.93，95%CI = 1.53-5.60，P < 0.01）， hypotension （OR = 5.24，95%CI = 1.94-14.13，P < 0.01）， mechanical ventilation （OR = 3.52，95%CI = 2.19-5.67，P < 0.01），length of ICU stay （OR = 1.64，95%CI = 1.14-2.35，P < 0.01），acute physiology and chronic health evalua-tion scoring system Ⅱ score （OR = 1.11，95%CI= 1.00 - 1.23，P < 0.05） and sequential organ failure assessment score （OR=1.12，95%CI=1.03-1.21，P<0.01） were risk factors for AGI in critically ill patients. And antral motility index （OR=0.33，95%CI=0.17-0.62，P<0.01） was a protective factor. Conclusion There are many factors affecting the occurrence of AGI in critically ill patients. Healthcare professionals should identify relevant factors as early as possible，and implement targeted prevention and treatment measures to reduce the incidence of AGI and related complications，so as to improve the clinical prognosis of critically ill patients.

Key words: Critically Ill Patients, Acute Gastrointestinal Injury, Influencing Factors, Meta-Analysis, Eviden-ce-Based Nursing

方波, 沈志杰, 王艳. 危重患者急性胃肠损伤影响因素的Meta分析[J]. 中华急危重症护理杂志, 2025, 6(11): 1377-1385.

FANG Bo, SHEN Zhijie, WANG Yan. Influencing factors of acute gastrointestinal injury in critically ill patients：a meta-analysis[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(11): 1377-1385.

图/表 7

表1

图1

表2

图2

图3

表3

表4

参考文献 30

[1]	Reintam Blaser A, Malbrain MLNG, Starkopf J, et al. Gastroin-testinal function in intensive care patients:terminology,defini-tions and management. Recommendations of the ESICM Wor-king Group on Abdominal Problems[J]. Intensive Care Med, 2012, 38(3):384-394. doi: 10.1007/s00134-011-2459-y pmid: 22310869
[2]	叶俊男. ICU患者急性胃肠损伤的危险因素分析及早期肠内营养应用价值[D]. 杭州: 浙江中医药大学, 2022.
	Ye JN. Analysis of the risk factors of acute gastrointestinal injury in ICU patients and application value of early enteral nutrition[D]. Hangzhou: Zhejiang Chinese Medical University, 2022.
[3]	Wang YQ, Li YH, Zhang YH, et al. Development and validation of a nomogram for predicting 28-day mortality in critically ill patients with acute gastrointestinal injury:prospective observa-tional study[J]. Front Nutr, 2024,11:1469870.
[4]	Page MJ, Mckenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement:an updated guideline for reporting systematic re-views[J]. BMJ, 2021, 372(3):n71.
[5]	曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四:观察性研究的质量评价工具[J]. 中国循证心血管医学杂志, 2012, 4(4):297-299.
	Zeng XT, Liu H, Chen X, et al. Meta-analysis series part four:quality assessment tools for observational studie[J]. Chin J Evid Based Cardiovasc Med, 2012, 4(4):297-299.
[6]	Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605. doi: 10.1007/s10654-010-9491-z pmid: 20652370
[7]	肖武强, 何再明, 党宗彦, 等. 脓毒症合并急性胃肠损伤的危险因素分析[J]. 中国急救医学, 2016, 36(1):35-38.
	Xiao WQ, He ZM, Dang ZY, et al. A investigation about the risk factors for sepsis with acute gastrointestinal injury(AGI)[J]. Chin J Crit Care Med, 2016, 36(1):35-38.
[8]	姜文学, 韦巧, 王驰, 等. 老年ECMO患者早期急性胃肠损伤发生的影响因素分析[J]. 医学信息, 2023, 36(12):91-95.
	Jiang WX, Wei Q, Wang C, et al. Analysis of influencing factors of early acute gastrointestinal injury in elderly patients with ECMO[J]. J Med Inf, 2023, 36(12):91-95.
[9]	刘宁, 苏立杰, 许树长, 等. 脓毒症合并急性胃肠损伤的危险因素与预后调查分析[J]. 同济大学学报(医学版), 2015, 36(2):53-58.
	Liu N, Su LJ, Xu SC, et al. Risk factors of occurrence and prognosis of acute gastrointestinal injury in patients with sepsis[J]. J Tongji Univ Med Sci, 2015, 36(2):53-58.
[10]	张静, 齐咏. 脓毒症呼吸衰竭患者急性胃肠损伤危险因素分析[J]. 中国急救医学, 2017, 37(11):969-972.
	Zhang J, Qi Y. The risk factors of acute gastrointestinal injury of sepsis patients with respiratory failure[J]. Chin J Crit Care Med, 2017, 37(11):969-972.
[11]	刘景刚, 张珂, 袁继印, 等. 早期活动对慢性阻塞性肺疾病有创机械通气继发急性胃肠损伤患者危险因素影响的临床研究[J]. 中国医师杂志, 2019, 21(2):207-211.
	Liu JG, Zhang K, Yuan JY, et al. A clinical study on the effect of early activities on risk factors of acute gastrointes-tinal injury in patients with chronic obstructive pulmonary di-sease induced by mechanical ventilation[J]. J Chin Physician, 2019, 21(2):207-211.
[12]	潘春熹, 陈万, 吕立文, 等. 老年脓毒性休克患者急性胃肠道损伤超声表现及相关性研究[J]. 临床急诊杂志, 2020, 21(4):261-266.
	Pan CX, Chen W, Lü LW, et al. Ultrasound manifestations on aute gastrointestinal injury in elderly patients with septic shock and related studies[J]. J Clin Emerg, 2020, 21(4):261-266.
[13]	王亚飞, 冯鹏远. 重症胰腺炎患者胃肠功能障碍的状况分析[J]. 医药论坛杂志, 2022, 43(4):77-79,83.
	Wang YF, Feng PY. Analysis of gastrointestinal dysfunction in patients with severe pancreatitis[J]. J Med Forum, 2022, 43(4):77-79,83.
[14]	杨思雯, 李思耐, 张鑫, 等. 脓毒症急性胃肠损伤危险因素分析及中医干预观察[J]. 世界中医药, 2022, 17(8):1140-1144.
	Yang SW, Li SN, Zhang X, et al. Risk factors of acute gas-trointestinal injury in sepsis and effect of TCM[J]. World Chin Med, 2022, 17(8):1140-1144.
[15]	姜冀, 张玉萍, 金晓畅, 等. 机械通气患者急性胃肠损伤现状及高危因素分析[J]. 全科医学临床与教育, 2021, 19(7):642-644.
	Jiang J, Zhang YP, Jin XC, et al. Analysis of the current status and risk factors for acute gastrointestinal injury in mechanically ventilated patients[J]. Clin Educ Gen Pract, 2021, 19(7):642-644.
[16]	Lu RL, Yang BW. Incidence and influencing factors of acute gastrointestinal injury after cardiac surgery[J]. BMC Cardiova-sc Disord, 2023, 23(1):437.
[17]	成慧昕, 史星宇, 于湘友. 脓毒症继发急性胃肠损伤的危险因素分析[J]. 临床医学进展, 2023, 13(4):6522-6529.
	Chen HX, Shi XY, Yu XY. Analysis of risk factors for acute gastrointestinal injury secondary to sepsis[J]. Advan Clin Med, 2023, 13(4):6522-6529.
[18]	陈万, 潘春熹, 吕立文, 等. 胃肠道超声联合血乳酸对重症患者急性胃肠道损伤的诊断价值[J]. 中华急诊医学杂志, 2020, 29(7):959-964.
	Chen W, Pan CX, Lü LW, et al. The diagnostic value of motility index,superior mesenteric artery time averaged mean velocity and blood lactic acid level for acute gastrointestinal injury in critical patients[J]. Chin J Emerg Med, 2020, 29(7):959-964.
[19]	Fu WP, Hu ZH, Zhou XM, et al. Establishment and evaluation of a prediction model for acute gastrointestinal injury in patients with prolonged disorder of consciousness[J]. BMC Gas-troenterol, 2022, 22(1):440.
[20]	陈福进, 姚莉, 赵晶晶. 多发伤后急性胃肠损伤预测模型建立和评价[J]. 中国急救医学, 2021, 41(11):972-976.
	Chen FJ, Yao L, Zhao JJ. Establishment and evaluation of a prediction model for acute gastrointestinal injury after multiple trauma[J]. Chin J Crit Care Med, 2021, 41(11): 972-976.
[21]	Reintam A, Parm P, Redlich U, et al. Gastrointestinal failure in intensive care:a retrospective clinical study in three dif-ferent intensive care units in Germany and Estonia[J]. BMC Gastroenterol, 2006,6:19.
[22]	Chaudhry R, Zaki J, Wegner R, et al. Gastrointestinal compli-cations after cardiac surgery:a nationwide population-based analysis of morbidity and mortality predictors[J]. J Cardio-thorac Vasc Anesth, 2017, 31(4):1268-1274.
[23]	Nguyen T, Frenette AJ, Johanson C, et al. Impaired gastrointe-stinal transit and its associated morbidity in the intensive care unit[J]. J Crit Care, 2013, 28(4):537.e11-537.e5.37E17. doi: 10.1016/j.jcrc.2012.10.037
[24]	Ladopoulos T, Giannaki M, Alexopoulou C, et al. Gastrointe-stinal dysmotility in critically ill patients[J]. Ann Gastroente-rol, 2018, 31(3):273-281.
[25]	Remund B, Yilmaz B, Sokollik C. D-lactate:implications for gastrointestinal diseases[J]. Children, 2023, 10(6):945. doi: 10.3390/children10060945
[26]	Gupta HP, Khichar PR, Porwal R, et al. The duration of intra-abdominal hypertension and increased serum lactate level are important prognostic markers in critically ill surgical patient's outcome:a prospective,observational study[J]. Niger J Surg, 2019, 25(1):1-8. doi: 10.4103/njs.NJS_7_18
[27]	朱苑霞, 郑燕华, 蔡艳. ICU机械通气患者腹内压与肠内营养喂养不耐受的相关性[J]. 护理实践与研究, 2021, 18(2):175-178.
	Zhu YX, Zheng YH, Cai Y. Correlation between intra-abdomi-nal pressure and enteral nutrition feeding intolerance in patients with mechanical ventilation in ICU[J]. Nurs Pract Res, 2021, 18(2):175-178.
[28]	李志茹, 王华芬, 卢芳燕, 等. 成人ICU患者腹内高压危险因素的Meta分析[J]. 中华急危重症护理杂志, 2023, 4(9):792-798.
	Li ZR, Wang HF, Lu FY, et al. Risk factors of intra-abdo-minal hypertension in adult ICU patients:a Meta-analysis[J]. Chin J Emerg Crit Care Nurs, 2023, 4(9):792-798.
[29]	Klanovicz TM, Franzosi OS, Nunes DSL, et al. Acute gastroin-testinal failure is associated with worse hemodynamic and perfusion parameters over 48 h after admission in patients with septic shock:retrospective cohort study[J]. Nutr Clin Pract, 2023, 38(3):617-627. doi: 10.1002/ncp.v38.3
[30]	王艳, 王建荣, 唐晟, 等. 危重患者急性胃肠损伤现状及影响因素的调查研究[J]. 国际消化病杂志, 2017, 37(1):54-58.
	Wang Y, Wang JR, Tang S, et al. A multiple-center observa-tional study of acute gastrointestinal injury and its influential factors in critically ill patients[J]. Int J Dig Dis, 2017, 37(1):54-58.