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| I-FEED评分系统在脊柱手术患者术后胃肠功能评价中的应用 |
| Application of I-FEED scoring system in evaluating postoperative gastrointestinal function in patients undergoing spinal surgery |
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| DOI：10.12089/jca.2025.10.004 |
| 中文关键词: I-FEED评分系统 脊柱手术 胃肠功能 |
| 英文关键词: I-FEED scoring system Spine surgery Gastrointestinal function |
| 基金项目:南京市卫生科技发展专项资金项目（YKK23065） |
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| 中文摘要: |
目的：探讨进食-恶心感-呕吐-查体-症状持续时间（I-FEED）评分系统在脊柱手术患者术后胃肠功能评价中应用的临床价值。
方法：选择2022年6月至2023年10月择期行脊柱手术的患者181例，男79例，女102例，年龄15～79岁，ASA Ⅰ—Ⅳ级。在术后1—3 d进行I-FEED评分，将每天I-FEED评分相加，根据总分将患者分为三组：正常组（I-FEED总分0～2分）、术后胃肠不耐受组（POGI组，I-FEED总分3～5分）和术后胃肠功能障碍组（POGD组，I-FEED总分≥6分）。记录术后1、2、3 d I-FEED评分、静息和活动时VAS疼痛评分和舒适度评分。记录手术时间、芬太尼用量、输血量、出血量、输液量、镇痛泵使用情况。记录术后首次进流食时间、术后首次肠鸣音出现时间、术后首次肛门排气时间、术后首次排便时间、PACU停留时间和术后住院时间。记录术中低血压和术后苏醒延迟的发生情况。评估I-FEED与相关指标的关联性。
结果：所有患者配合完成了I-FEED评分系统的评估，耗时不超过3 min，其中正常组108例（59.7%），POGI组35例（19.3%），POGD组38例（21.0%）。与正常组比较，POGI组使用镇痛泵的比例、有限的耐受经口进食的比例、对恶心感治疗有效的比例、出现呕吐的比例和查体出现腹胀并伴有鼓音的比例明显升高，术后首次肠鸣音出现时间、术后首次肛门排气时间明显延长，术后1、2 d舒适度评分明显降低（P<0.05）；POGD组使用镇痛泵的比例、完全不耐受经口进食的比例、出现恶心呕吐的比例、查体出现腹胀并伴有鼓音的比例、症状持续时间＞72 h的比例和使用促胃肠动力药物的比例明显升高，术后首次进流食时间、术后首次肠鸣音出现时间、术后首次肛门排气时间、术后首次排便时间和术后住院时间明显延长，术后1、2、3 d舒适度评分明显降低（P<0.05）。与POGI组比较，POGD组有限的耐受经口进食比例和对恶心感治疗有效的比例明显降低，完全不耐受经口进食的比例、对恶心感治疗无效的比例、≥1次少量呕吐和非胆汁性呕吐的比例、查体出现腹胀并伴有鼓音的比例、症状持续时间＞72 h的比例和使用促胃肠动力药物的比例明显升高，术后首次进流食时间明显延长（P<0.05）。线性回归模型结果显示，I-FEED评分系统可有效预测术后首次进流食时间、首次肠鸣音出现时间、首次肛门排气时间、术后1、2、3 d舒适度评分、术后使用促胃肠动力药以及术后住院时间。
结论：I-FEED评分系统可应用于脊柱术后患者胃肠功能的评估，及早发现并处理患者的胃肠不适，对于临床中提高患者的舒适度，精细化脊柱手术后的管理，具有一定的临床价值。 |
| 英文摘要: |
Objective: To explore the clinical value of the I-FEED (intake, feeling nauseated, emesis, exam, and duration of symptoms) scoring system in the evaluation of postoperative gastrointestinal function in patients undergoing spinal surgery.
Methods: A total of 181 patients scheduled for elective spinal surgery between June 2022 and October 2023 were enrolled, 79 males and 102 females, aged 15-79 years, ASA physical status Ⅰ-Ⅳ. I-FEED scores were collected 1 day, 2 days, and 3 days after surgery, I-FEED scores from these three days were added up and patients were dicided into three groups based on the total I-FEED scores: the normal group (total I-FEED score was 0-2 points), postoperative gastrointestinal intolerance (the POGI group, total I-FEED score was 3-5 points), and postoperative gastrointestinal dysfunction (the POGD group, total I-FEED score was ≥6 points). I-FEED scores, VAS pain scores at rest and during exercise, and comfort ratings were documented 1 day, 2 days, and 3 days after surgery. The time of the first liquid intake after surgery, the time of the first bowel sounds after surgery, the time of the first anal exhaust after surgery, the time of the first bowel movement after surgery, the duration of PACU stay, and the length of hospital stay after surgery were recorded. Occurrences of intraoperative hypotension and delayed emergence were recorded. The associations between I-FEED scores and these variables were analyzed.
Results: All patients completed the I-FEED assessment within 3 minutes, yielding 108 patients (59.7 %) in the normal group, 35 patients (19.3 %) in the POGI group, and 38 patients (21.0 %) in the POGD group. Compared with the normal group, the proportion of pain pumps used, limited tolerance to oral feeding, effective treatment for nausea, vomiting, abdominal distension accompanied by drum sounds during physical examination were significantly increased, the time of the first bowel sound and the first anal exhaust after surgery were significantly prolonged, and the comfort score 1 day and 2 days after surgery was significantly reduced in the POGI group (P < 0.05). Compared with the normal group, the proportion of pain pumps used, complete intolerance to oral feeding, nausea and vomiting, abdominal distension accompanied by drum sounds during physical examination, symptoms lasting for more than 72 hours, and using gastrointestinal motility promoting drugs were significantly increased, the time of the first liquid intake after surgery, the time of the first bowel sound after surgery, the time of the first anal exhaust after surgery, the time of the first bowel movement after surgery, and the length of hospital stay after surgery were significantly prolonged, the comfort scores 1 day, 2 days, and 3 days after surgery were significantly reduced in the POGD group (P < 0.05). Compared with the POGI group, the proportion of limited tolerance to oral feeding and effective treatment for nausea were significantly decreased, the proportion of complete intolerance to oral feeding, ineffective treatment for nausea, ≥ 1 episode of mild vomiting and non bile vomiting, abdominal distension with bulging sound during physical examination, symptoms lasting more than 72 hours, and using gastrointestinal motility promoting drugs were significantly increased, the time of the first liquid intake after surgery was significantly prolonged in the POGD group (P < 0.05). The results of the linear regression model showed that the I-FEED scoring system can effectively predict the time of first fluid intake after surgery, the time of first bowel sounds after surgery, the time of first anal exhaust after surgery, comfort scores 1 day, 2 days, and 3 days after surgery, the use of gastrointestinal motility promoting drugs after surgery, and the length of hospital stay after surgery.
Conclusion: The I-FEED scoring system can be applied to the evaluation of gastrointestinal function in patients after spinal surgery, allowing for early detection and management of gastrointestinal discomfort. It has certain clinical value in improving patient comfort and refining the management of patients after spinal surgery. |
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