危重症脑卒中神经介入术后流程化营养护理流程的构建、应用及戴明环持续改进研究

Study on the construction,application and Plan-Do-Check-Action continuous improvement of streamlined nutrition nursing process after neurointervention for severe stroke

目的研究危重症脑卒中神经介入术后流程化营养护理流程的构建、应用及戴明环(PDCA)持续改进效果。方法选取2021年1月至7月于江西省景德镇市第一人民医院神经内科重症监护病房(ICU)接受神经介入术的30例危重症脑卒中患者作为对照组,术后采用常规营养治疗方案。选取2021年8月至2022年1月于景德镇市第一人民医院神经内科ICU接受神经介入术的危重症脑卒中30例患者作为观察组,术后拟采用流程化营养护理流程,并采用戴明环持续改进。比较两组ICU住院时间、机械通气时间、28 d生存率、24、48 h内启动EN例数、7 d内肠内营养(EN)达到60%目标量例数、白蛋白(ALB)、美国国立卫生研究院卒中量表(NIHSS)评分、不良反应发生率。结果观察组ICU住院时间、机械通气时间短于对照组,28 d生存率高于对照组,差异有统计学意义(P<0.05)。两组48 h内启动EN例数比较,差异无统计学意义(P>0.05);观察组24 h内启动EN例数、7 d内EN达到60%目标量例数高于对照组,差异有统计学意义(P<0.05)。护理前两组ALB水平、NIHSS评分比较,差异无统计学意义(P>0.05);护理后两组患者的ALB水平高于护理前,且观察组ALB水平高于对照组;护理后两组患者的NIHSS评分低于护理前,且观察组NIHSS评分低于对照组,差异有统计学意义(P<0.05)。观察组不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论危重症脑卒中神经介入术后流程化营养护理流程的构建、应用及PDCA持续改进,可改善患者临床指标,获得较好的营养支持及预后情况,临床应当关注。

Objective To study the construction,application and effect of continuous improvement of Plan-Do-Check-Action(PDCA)of process-based nutritional care process after neurointervention in critically ill stroke.Methods Thirty patients with critical stroke who underwent neurointervention in the intensive care unit(ICU)of the Department of Neurology at the First People's Hospital of Jingdezhen,Jiangxi Province,from January to July 2021 were selected as the control group,and the conventional nutritional treatment protocol was used after surgery.A total of 30 patients with critical stroke who underwent neurointervention in the ICU of the Department of Neurology at the First People's Hospital of Jingdezhen from August 2021 to January 2022 were selected as the observation group,and the postoperative process of flow-based nutritional care was to be adopted.The length of ICU stay,duration of mechanical ventilation,28 d survival rate between the two groups were compared.The number of cases initiating EN within 24 h and 48 h,the number of cases reaching 60%target volume of enteral nutrition(EN)within 7 d,albumin(ALB),National Institutes of Health Stroke Scale(NIHSS)score,and the incidence of adverse reactions of the two groups were compared.Results The ICU stay and mechanical ventilation time in the observation group were shorter than those in the control group,and the 28 d survival rate was higher than that in the control group,and the differences were statistically significant(P<0.05).The differences were not statistically significant when comparing the number of cases of EN initiation within 48 h between the two groups(P>0.05);the number of cases of EN initiation within 24 h and the number of cases of EN reaching 60%of the target volume within 7 d were higher in the observation group than in the control group,and the differences were statistically significant(P<0.05).There were no statistically significant difference between the ALB level and NIHSS score of the two groups before nursing(P>0.05);the ALB level of the patients in the two groups after nursing was higher than that before nursing,and the ALB level of the observation group was higher than that of the control group;the NIHSS score of the patients in the two groups after nursing was lower than that before nursing,and the NIHSS score of the observation group was lower than that of the control group,and the differences were statistically significant(P<0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion The construction,application and continuous improvement of PDCA of streamlined nutritional nursing process after neurointerventional therapy for severe stroke can improve patients'clinical indicators,obtain better nutritional support and prognosis,which should be paid attention to clinically.