基于奥马哈系统的脑卒中鼻饲患者营养管理模式的构建与应用效果

Construct of nutrition management model of stroke patients with nasal feeding based on Omaha system and its application effect

目的构建基于奥马哈系统的脑卒中鼻饲患者营养管理多学科合作模式并评价其应用效果。方法以脑卒中鼻饲患者营养管理为核心,针对患者在医院、社区和家庭的不同需求,构建包含患者所有奥马哈护理问题、干预措施及结局评价的综合评估表,实施表格引导下的标准化干预。采用便利抽样法选取太原市中心医院2017年12月—2018年2月入住的65例脑卒中鼻饲患者为对照组,实施常规干预;选取2018年3—5月的65例为干预组,实施基于奥马哈系统的营养管理模式干预,分别比较两组患者插管后2周的营养状况变化及插管后1个月鼻饲相关并发症发生率。比较干预组患者插管时、插管后2周、插管后1个月的奥马哈认知、行为及状况得分改变。结果插管后2周两组脑卒中患者血清白蛋白、营养状况评分比较,差异均有统计学意义(P<0.05);插管后1个月,干预组患者腹泻、吸入性肺炎、便秘和意外拔管发生率明显低于对照组,差异有统计学意义(P<0.05),但呕吐和堵管改善尚不明显,差异无统计学意义(P>0.05)。干预组患者插管后2周和1个月奥马哈各项问题的认知、行为及状况评分均有不同程度的提升,差异有统计学意义(P<0.05)。结论奥马哈系统下的问题分类系统能使脑卒中鼻饲患者的护理问题评估更加系统和全面,有利于评估者发现传统护理中被忽视的问题,为制定针对性干预措施提供了方向。同时通过对患者护理结局的评价促进了护理人员对患者需求的动态掌握,改善了患者的营养状况和并发症发生结局。因此,基于奥马哈系统的脑卒中鼻饲患者营养管理模式适合应用于脑卒中鼻饲患者的全程管理,值得进一步探索和推广。

Objective To construct a multidisciplinary nutrition management model of stroke patients with nasal feeding based on Omaha system and to evaluate its effects. Methods With the core of nutrition management of stroke patients with nasal feeding and based on patients' needs in hospitals, communities and families, we constructed a comprehensive assessment scale which included Omaha nursing problems of patients, intervention and outcome evaluation. And then, we carried out standardized intervention under the guide of the scale. From December 2017 to February 2018, we selected 65 stroke patients with nasal feeding from Taiyuan City Centre Hospital in control group (routine intervention) by convenience sampling. From March to May 2018, we selected 65 patients from Taiyuan City Centre Hospital in intervention group (nutrition management model intervention based on Omaha system). We compared the nutrition condition two weeks after catheterization and incidence of nasal feeding related complications one month after catheterization of patients between two groups respectively. We also evaluated the scores of Omaha cognition, behavior and condition of patients at catheterization, two weeks and one month after catheterization. Results The serum albumin and nutritional status scores of the two groups of stroke patients were significantly different two weeks after intubation (P<0.05). One month after intubation, the intervention group had diarrhea, aspiration pneumonia, constipation and accident. The incidence of extubation was significantly lower than that of the control group, and the difference was statistically significant (P<0.05), but the improvement of vomiting and occlusion was not obvious, and the difference was not statistically significant (P>0.05). In intervention group, patients' scores of Omaha cognition, behavior and condition of patients two weeks and one month after catheterization all increased with statistical differences (P<0.05). Conclusions Problems classification system of Omaha system can systematically and comprehensively evaluate the nursing problems among stroke patients with nasal feeding which helps assessors to find the neglected problems in traditional nursing and provides direction for formulating targeted intervention. Assessment for nursing outcomes promotes nurses to dynamically master patients' needs and improves patients' nutrition condition and incidence of complications. Therefore, nutrition management model of stroke patients with nasal feeding based on Omaha system is suitable for whole process management of stroke patients with nasal feeding which is worthy of being explored and popularized.