危重症患者早期肠内营养治疗中实施规范化流程管理的效果观察

Effect of Standardized Process Management in Early Enteral Nutrition Therapy for Critically Ill Patients

目的:观察危重症患者早期肠内营养(EEN)治疗中实施规范化流程管理的效果。方法:选取2017年4月-2019年12月本院收治的重症患者226例,以2018年5月1日为时间节点,将2017年4月1日-2018年4月30日EEN治疗中未实施规范化流程管理的患者作为对照组(n=98),2018年5月1日-2019年12月31日EEN治疗中实施规范化流程管理的患者作为观察组(n=128)。比较两组营养治疗第7、14天血清白蛋白(ALB)、日供热量和日供蛋白达标比、最低血糖(BGmin)、最高血糖(BGmax)、血糖变异系数(BGcv)、低磷血症发生情况、胃肠耐受性评分,并比较两组感染性并发症发生情况、EN中断时间和住ICU时间。结果:观察组治疗第7、14天ALB、日供热量和日供蛋白达标比、BGmin均高于对照组,差异均有统计学意义(P<0.05)。观察组治疗第7、14天BGmax、BGcv、低磷血症发生率、胃肠耐受性评分均低于对照组,差异均有统计学意义(P<0.05)。观察组感染性并发症发生率低于对照组,EN中断时间、住ICU时间均短于对照组,差异均有统计学意义(P<0.05)。结论:危重症患者EEN治疗中实施规范化流程管理能维持其血清白蛋白水平,改善负氮平衡;提高热量和蛋白供给达标比;纠正糖代谢紊乱;减少肠内营养的中断时间,改善患者营养状况,提升胃肠耐受性,降低感染性并发症发生率,缩短住ICU时间。在实际工作中有推广意义。

Objective:To observe the effect of standardized process management in early enteral nutrition(EEN)therapy for critically ill patients.Method:A total of 226 critically ill patients admitted to our hospital from April 2017 to December 2019 were selected.Taking May 1,2018 as the time node,patients who had not implemented standardized process management in the treatment of EEN from April 1,2017 to April 30,2018 were taken as the control group(n=98),and patients who had implemented standardized process management in the treatment of EEN from May 1,2018 to December 31,2019 were taken as the observation group(n=128).The serum albumin(ALB),daily heat supply,standard ratio of daily protein supply,minimum blood glucose(BGmin),maximum blood glucose(BGmax),blood glucose coefficient of variation(BGcv),incidence of hypophosphatemia,gastrointestinal tolerance score were compared between two groups at the 7th and 14th day of nutritional treatment.The incidence of infectious complications,EN interruption time and ICU stay time of two groups were compared.Result:The ALB,daily heat supply,standard ratio of daily protein supply and BGmin in the observation group at the 7th and 14th day of nutritional treatment were higher than those in the control group,the differences were statistically significant(P<0.05).The BGmax,BGcv,incidence of hypophosphatemia and gastrointestinal tolerance score of the observation group at the 7th and 14th day of nutritional treatment were lower than those of the control group,the differences were statistically significant(P<0.05).The incidence of infectious complications in the observation group was lower than that in the control group,and the EN interruption time and ICU stay time were shorter than those in the control group,the differences were statistically significant(P<0.05).Conclusion:The implementation of standardized process management in EEN treatment of critically ill patients can maintain their serum albumin level,improve the negative nitrogen balance,increase the standard ratio of heat and protein supply,correct glucose metabolism disorder,reduce the interruption time of enteral nutrition,improve the nutritional status of patients,enhance gastrointestinal tolerance,reduce the incidence of infectious complications and shorten the time of ICU stay.It can be popularized in practical work.