重症脑卒中患者早期滋养型肠内营养流程的制订与应用

doi:10.3761/j.issn.0254-1769.2022.19.001

摘要/Abstract

摘要：

目的制订重症脑卒中患者早期滋养型肠内营养流程并评价其应用效果。方法通过文献检索、最佳证据总结、专家咨询及临床试运行制订重症脑卒中患者早期滋养型肠内营养流程。采取便利抽样法,连续选取2020年1月—2021年12月于苏州市某三级甲等医院神经内科病房收治的重症脑卒中患者作为研究对象,其中,2021年1月—12月收治的49例作为试验组,2020年1月—12月收治的50例作为对照组。试验组实施早期滋养型肠内营养流程,对照组实施常规肠内营养支持治疗,比较两组喂养不耐受的发生情况及营养指标。结果试验组腹泻、便秘、喂养中断发生率低于对照组（P<0.05）;试验组住院7 d后血红蛋白值与入院时基本一致,差异无统计学意义（P>0.05）,对照组住院7 d后血红蛋白值较入院时下降（P<0.05）;两组住院7 d后血浆白蛋白水平较入院时均降低（P<0.05）,但试验组下降幅度低于对照组（P=0.046）。结论早期滋养型肠内营养流程可降低重症脑卒中患者腹泻、便秘及喂养中断的发生率,并促进其血红蛋白的恢复,减缓白蛋白水平的下降。

关键词: 早期肠内营养, 滋养型喂养, 重症脑卒中, 流程管理, 护理

Abstract:

Objective To develop a process for early tonic enteral nutrition in patients with severe stroke and to evaluate its effectiveness. Methods We developed an early nourishing enteral nutrition process for patients with severe stroke through literature search,best evidence summaries,expert consultations and clinical trials. A convenience sampling method was used to consecutively select patients with severe stroke admitted to the neurology ward of a tertiary care hospital in Suzhou from January 2020 to December 2021 as the study population. Among them,patients admitted from January 2021 to December 2021 were set as the test group with a total of 49 cases,and those from January 2020 to December 2020 were set as the control group with a total of 50 cases. The test group implemented the early nourishing enteral nutrition process,and the control group implemented the conventional enteral nutrition support treatment,comparing the occurrence of feeding intolerance and nutritional indicators between the 2 groups. Results The incidences of diarrhea,constipation and feeding interruption in the test group were lower than those in the control group significantly（P<0.05）. The hemoglobin value in the control group decreased significantly after 7 days of hospitalization,compared with that at the time of admission（P<0.05）,but the hemoglobin value in the test group remained basically balanced with that at the time of admission after 7 days of hospitalization,and the difference was not statistically significant（P>0.05）. The plasma albumin level in both the test and control groups decreased significantly after 7 days of hospitalization,compared with that at the time of admission（P<0.05）,but the decrease in the test group was lower than that in the control group significantly（P=0.046）. Conclusion Early nourishing enteral nutrition process can reduce the incidence of diarrhea,constipation and feeding interruptions significantly,while promoting the recovery of hemoglobin and slowing the decline of albumin levels in patients with severe stroke.

Key words: Early Enteral Nutrition, Nourishing Feeding, Severe Stroke, Process Management, Nursing Care

潘习, 王稚, 黄盛, 马铮铮, 王达鹏, 杨晶, 徐岚. 重症脑卒中患者早期滋养型肠内营养流程的制订与应用[J]. 中华护理杂志, 2022, 57(19): 2309-2315.

PAN Xi, WANG Zhi, HUANG Sheng, MA Zhengzheng, WANG Dapeng, YANG Jing, XU Lan. Development and application of an early nourishing enteral nutrition process in patients with severe stroke[J]. Chinese Journal of Nursing, 2022, 57(19): 2309-2315.

图/表 4

图1 重症脑卒中患者早期滋养型肠内营养流程注：AGI为急性胃肠损伤分级评分。1 mmHg=0.133 kPa。

Figure 1 Early nourishing enteral nutrition process in patients with severe stroke

表1 两组一般资料比较

Table 1 Comparison of general data between the 2 groups

表2 两组肠内营养不耐受及喂养中断的发生率比较[例（百分率,%）]

Table 2 Comparison of the incidence of enteral nutrition intolerance and feeding interruption between the 2 groups[case（percent,%）]

表3 两组营养相关指标比较（g/L）

Table 3 Comparison of nutrition-related indicators between the 2 groups（g/L）

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