PDCA管理模式在食管癌管饲患者喂养不耐受管理中的应用

Application of PDCA Management Mode in the Management of Feeding Intolerance in Tube-feeding Patients with Esophageal Cancer

目的:探讨PDCA管理模式在食管癌管饲患者喂养不耐受管理中的应用效果。方法:回顾性分析2020年7月—2021年12月在厦门大学附属第一医院肿瘤放疗科住院的145例食管癌管饲患者的临床资料,将2020年7月—2021年3月收治的食管癌管饲患者作为对照组采取常规护理,2021年4—12月收治的食管癌管饲患者作为研究组实施PDCA管理模式。观察PDCA实施情况。比较两组的喂养不耐受率、全肠内营养支持率、主观整体营养状况评量表(PG-SGA)评分、前白蛋白、血清白蛋白、淋巴细胞计数。结果:PDCA实施后,医务人员营养知识培训及考核合格率为100.0%(9/9);营养液输注速度控制的准确率为100.0%(75/75);营养科24 h内进行营养会诊率由实施前的85.7%(60/70)提升至96.0%(72/75);低蛋白患者,高蛋白配方肠内营养制剂使用率及鱼皮肽添加率均为100.0%(35/35);康复运动知识知晓率为82.7%(62/75);患者每日运动时间由实施前的(12.36±5.30)min/d提升至(27.68±8.90)min/d。研究组的喂养不耐受率为21.33%,低于对照组的47.14%(P<0.05);研究组的全肠内营养支持率为68.00%,高于对照组的44.29%,差异有统计学意义(P<0.05)。研究组的PG-SGA评分低于对照组,淋巴细胞计数、前白蛋白均高于对照组,差异均有统计学意义(P<0.05);两组的血清白蛋白比较,差异无统计学意义(P>0.05)。结论:PDCA管理模式的实施有助于降低食管癌管饲患者喂养不耐受的发生率,提高全肠内营养支持率,从而提高患者营养水平。

Objective: To investigate the application effect of PDCA management mode in the management of tube-feeding intolerance in patients with esophageal cancer. Method: The clinical data of 145 esophageal cancer tube-feeding patients hospitalized in the Cancer and Radiotherapy Department of the First Affiliated Hospital of Xiamen University from July 2020 to December 2021 were analyzed retrospectively. The patients with esophageal cancer who were treated by tube-feeding from July 2020 to March 2021 were selected as the control group for routine nursing, and the patients with esophageal cancer who were treated by tube-feeding from April to December 2021 were selected as the research group for PDCA management mode. The implementation of PDCA was observed. The feeding intolerance rate, total enteral nutrition support rate, patient-generated subjective global assessment(PG-SGA) score, prealbumin,serum albumin and lymphocyte count of the two groups were compared. Result: After the implementation of PDCA, the qualified rate of nutrition knowledge training and assessment for medical staff was 100.0%(9/9);the accuracy of nutrient solution infusion rate control was 100.0%(75/75);the rate of nutrition consultation in the nutrition department within 24 h increased from 85.7%(60/70) before implementation to 96.0%(72/75);for low protein patients, the use rate of high protein formula enteral nutrition preparation and fish skin peptide addition rate were 100.0%(35/35);the awareness rate of rehabilitation exercise knowledge was 82.7%(62/75);the daily exercise time of patients increased from(12.36±5.30) min/d before implementation to(27.68±8.90) min/d. The feeding intolerance rate in the research group was 21.33%, which was lower than 47.14% in the control group(P<0.05). The total enteral nutrition support rate in the research group was 68.00%, which was higher than 44.29% in the control group, the difference was statistically significant(P<0.05). The PG-SGA score of the research group was lower than that of the control group, and the lymphocyte count and prealbumin were higher than those of the control group, the differences were statistically significant(P<0.05). There was no significant difference in serum albumin between the two groups(P>0.05). Conclusion: The implementation of PDCA management mode helps to reduce the incidence of feeding intolerance, and improve the rate of total intestinal nutrition support, thus improving the nutritional level of patients.