Protective effects of enteral nutrition on proton pump inhibitor⁃caused gastrointestinal adverse reactions in ICU patients：a cross⁃sectional study
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摘要:
目的：观察肠内营养对危重患者质子泵抑制剂（proton pump inhibitors，PPIs）相关的消化道不良反应的作用。方法：采用横断面研究，对全国100家医院ICU内2017年4月25日住院的所有患者（不包括当天新入院患者）进行问卷调查。所用问卷包括自行设计问卷和标准化问卷，了解患者一般情况、使用的药物和治疗、营养实施情况、喂养耐受性评估、实验室检查结果、体重指数（body mass index，BMI）、急性胃肠损伤（acute gastrointestinal injury，AGI）分级、SOFA（sepsis-related organ failure）评分、急性生理功能和慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHE-Ⅱ）评分等。采用单因素分析使用PPIs是否对胃肠功能有所影响，多因素Logistic回归模型考察肠内营养是否为患者发生AGI的影响因素。结果：①未给予肠内营养的508例患者中，使用PPIs的401例（78.9%），未使用PPIs的107例（21.1%）。使用PPIs组的AGI 2~3级和AGI 4级的患者比例（17.0%和3.8%）明显高于非PPIs组（9.3%和1.9%），差异有统计学意义（P=0.027）；②1 138例使用过PPIs的患者中，已开始肠内营养的724例（63.6%）患者AGI分级评分（AGI 2~3级为10.5%，AGI 4级为0.7%）优于未开始肠内营养的401例（35.2%）患者（AGI 2~3级为17.0%，4级为3.8%），差异有统计学意义（P＜0.001）。但两组在28 d转归方面差异无统计学意义。多因素Logistic回归结果显示，肠内营养为AGI评分的独立保护因素（OR=0.353，95%CI：0.242~0.513，P＜0.001）。结论：肠内营养与保护PPIs所导致的ICU患者胃肠功能损伤存在关联性，但未发现其与患者死亡率降低有关。
Abstract:
Objective：The study aimed to evaluate effects of enteral nutrition on proton pump inhibitors（PPI）-caused adverse gastrointestinal reactions in critically ill patients. Methods：As a cross-sectional study，the study involved all hospitalized patients in the ICUs of 100 hospitals all over the country on April 25th，2017（patients newly admitted on April 25th were excluded）. Self-designed questionnaire items and a standard questionnaire were used. The self-designed questionnaire was composed by patient’s general profile，administered drugs and treatment，nutrition administration，feeding intolerance evaluation and lab test results，while the standardized questionnaire included body mass index（BMI），grade of acute gastrointestinal injury（AGI），sepsis-related organ failure（SOFA）score and acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）score. Single factor analysis was used to investigate whether PPIs could affect gastrointestinal function in patients. Multivariate logistic regression models were performed to investigate whether enteral nutrition has an effect on AGI. Results：①Among the 508 patients who were not given enteral nutrition，a total of 401 patients（78.9%）used PPIs，while the rest 107 patients（21.1%）did not. AGI Grade 4 and Grade 2-3 cases accounted for 3.8% and 17.0% of patients with PPIs treatment，which was significantly higher than that（1.9% and 9.3%，respectively）of non-PPIs groups（P=0.027）. ②Among the 1，138 patients with PPIs administration，724 patients（63.6%）had started enteral nutrition，their AGI score（10.5%，Grade 2-3；0.7%，Grade 4）was superior to the rest 401 cases（35.2%）without enteral nutrition（17.0%，Grade 2-3；3.8%，Grade 4；P < 0.001）. However，the two groups suggested no statistically significant difference in 28-day prognosis. According to the result of multivariable logistic regression，enteral nutrition was an independent protection factor for gastrointestinal function（OR=0.353，95% CI：0.242-0.513，P < 0.001）. Conclusion：Enteral nutrition has an association with protecting ICU patients against PPI-caused adverse reactions of gastrointestinal dysfunction and it does not reduce the death rate.
