精细化管理模式对重型颅脑损伤患者肠内营养治疗相关并发症及营养状况的影响

Effect of refined management mode on enteral nutrition related complications and nutritional status in patients with severe craniocerebral injury

目的探讨精细化管理模式在重型颅脑损伤患者肠内营养治疗中的应用效果。方法选取2018年5月至2020年5月本院收治的80例重型颅脑损伤患者作为研究对象,随机分为对照组和观察组,每组40例。对照组肠内营养治疗期间予以常规护理,观察组肠内营养治疗期间实施精细化管理模式,比较两组并发症发生情况、营养状况(白蛋白、前白蛋白、血红蛋白)及预后指标[ICU留置时间、出院时格拉斯哥预后评分(GOS)]。结果两组感染、电解质紊乱发生率比较差异无统计学意义;观察组反流/误吸、腹胀/便秘及腹泻发生率均低于对照组,差异具有统计学意义(P<0.05)。入院时,两组血清白蛋白、前白蛋白、血红蛋白水平比较差异无统计学意义;干预14 d后,两组血清白蛋白、前白蛋白及血红蛋白水平均高于入院时,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组ICU留置时间短于对照组,出院时GOS评分高于对照组,差异有统计学意义(P<0.05)。结论精细化管理模式应用于重型颅脑损伤患者肠内营养治疗期间,能有效降低并发症发生率,改善营养状况及预后。

Objective To investigate the effect of fine management mode in enteral nutrition treatment of patients with severe craniocerebral injury.Methods 80 patients with severe craniocerebral injury admitted to our hospital from May 2018 to May 2020 were selected as the research objects,and they were randomly divided into control group and observation group,with 40 cases in each group.The control group was given routine care during enteral nutrition treatment,and the observation group was given refined management mode during enteral nutrition treatment,the incidence of complications,nutritional status(albumin,prealbumin,hemoglobin)and prognostic indicators[ICU retention time,Glasgow prognosis score(GOS)at discharge]were compared between the two groups.Results There was no significant difference in the incidence of infection and electrolyte disturbance between the two groups.The incidence of reflux/aspiration,bloating/constipation and diarrhea in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).At admission,there was no significant difference in the levels of serum albumin,prealbumin and hemoglobin between the two groups;after 14 d of intervention,the levels of serum albumin,pre-albumin and hemoglobin in the twp groups were higher than those at admission,and the observation group was higher than the control group,the difference was statistically significant(P<0.05).ICU retention time in observation group was shorter than control group,GOS score at discharge was higher than control group,the difference was statistically significant(P<0.05).Conclusion Refined management mode applied to patients with severe craniocerebral injury during enteral nutrition treatment can effectively reduce the incidence of complications,improve nutritional status and prognosis.