Supplementary Material for: Using Electronic Medical Records of Nursing Care to Characterize Constipation in Patients with Intracerebral Hemorrhage

Introduction: Constipation is one of the common poststroke complications that directly affect the patients’ quality of life in patients with intracerebral hemorrhage (ICH), which has not been paid enough attention. Objective: This study investigates constipation’s clinical characteristics and its risk factors in ICH patients driven by the electronic medical records of nursing care. Methods: This retrospective chart review investigated patients with acute spontaneous ICH admitted at a tertiary care center from October 2010 to December 2018. Poststroke constipation was defined as a first stool passage occurring after 3 days postadmission and the use of enemas or laxatives after ICH. The associations between constipation present and potential factors were evaluated. Results: Of 1,748 patients, 408 (70.3% men, mean age 58 ± 14 years) patients with poststroke constipation were identified. After adjusting for potential confounding variables, the risk factors independently associated with poststroke constipation are admission Glasgow Coma Scale score (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.44–0.88; p = 0.007), use of mechanical ventilation (OR 3.74, 95% CI 2.37–5.89, p < 0.001), enteral nutrition (OR 2.82, 95% CI 1.85–4.30, p < 0.001), hematoma evacuation (OR 2.10, 95% CI 1.40–3.16; p < 0.001), opioid analgesics (OR 1.86, 95% CI 1.32–2.62; p < 0.001), sedation (OR 1.83, 95% CI 1.20–2.77; p = 0.005), and vasopressors (OR 1.81, 95% CI 1.26–2.61; p = 0.001) in order. Similar associations were observed in the prespecified length of the stay subgroup. Patients with constipation were associated with a longer hospital stay length (2.24 days, 95% CI 1.43–3.05, p < 0.001) but not with in-hospital mortality (OR 1.05, 95% CI 0.58–1.90, p = 0.871). Conclusions: Our findings suggested that risk factors influence the absence of constipation after ICH with the synergy of different weights. The occurrence of constipation likely affects a longer length of stay, but not in-hospital mortality. Future prospective investigations are warranted to validate our findings and identify the optimal management of constipation that may improve the quality of life in patients with ICH.引言：便秘是脑出血（intracerebral hemorrhage, ICH）患者常见的卒中后并发症之一，可直接影响患者生活质量，但目前尚未得到足够重视。 研究目的：本研究依托护理电子病历，探讨脑出血患者卒中后便秘的临床特征及其危险因素。 研究方法：本研究为回顾性病历审查，纳入2010年10月至2018年12月期间于某三级医疗中心收治的急性自发性脑出血患者。本研究将卒中后便秘定义为：入院后3天以上首次排便，且脑出血后使用灌肠剂或泻药。本研究对存在便秘的患者与潜在影响因素之间的关联进行了评估。 研究结果：本研究共纳入1748例患者，其中408例确诊为卒中后便秘（男性占70.3%，平均年龄58±14岁）。在校正潜在混杂变量后，与卒中后便秘独立相关的危险因素按关联强度从高到低依次为：入院时格拉斯哥昏迷量表（Glasgow Coma Scale）评分（比值比[odds ratio, OR]=0.62，95%置信区间[confidence interval, CI]=0.44~0.88；p=0.007）、机械通气使用（OR=3.74，95%CI=2.37~5.89，p<0.001）、肠内营养（OR=2.82，95%CI=1.85~4.30，p<0.001）、血肿清除术（OR=2.10，95%CI=1.40~3.16；p<0.001）、阿片类镇痛药使用（OR=1.86，95%CI=1.32~2.62；p<0.001）、镇静治疗（OR=1.83，95%CI=1.20~2.77；p=0.005）以及血管加压药使用（OR=1.81，95%CI=1.26~2.61；p=0.001）。在预先设定的住院时长亚组中也观察到了相似的关联。便秘患者的住院时长较无便秘患者延长2.24天（95%CI=1.43~3.05，p<0.001），但住院死亡率与无便秘患者无显著差异（OR=1.05，95%CI=0.58~1.90，p=0.871）。 结论：本研究结果表明，不同权重的危险因素协同作用，影响脑出血患者卒中后便秘的发生风险。便秘的发生可能会延长患者住院时长，但对住院死亡率无显著影响。未来需开展前瞻性研究以验证本研究结果，并明确可改善脑出血患者生活质量的便秘最优管理方案。