分段式肠内营养联合消化液回输改善重症肠瘘病人营养状况的护理研究

Nursing study of segmented enteral nutrition combined with fistuloclysis to improve the nutritional status of patients with severe intestinal fistula

目的:研究分段式肠内营养联合消化液回输对于改善重症肠瘘病人的营养状况效果,探讨营养支持方式对重症肠瘘预后的影响,为重症肠瘘病人提供护理参考。方法:选择2023年2月~2023年8月东部战区总医院普通外科重症监护病房收治的96例并发多个瘘的重症肠瘘病人。根据营养支持方式分为干预组(n=47)和对照组(n=49),干预组采用分段式肠内营养联合消化液回输,对照组采用分段式肠内营养。在肠内营养干预后14 d收集指标比较两组差异,营养状况指标包括BMI、血清白蛋白水平、总蛋白水平、血红蛋白水平,炎症指标包括血清C反应蛋白(CRP)、白介素-6(IL-6),肠内营养不耐受症状发生率,以及ICU总住院时间、总住院费用等预后相关指标。结果:干预后14 d干预组血清总蛋白为(71.55±7.00)g/L、血红蛋白为(106.64±15.59)g/L,显著高于对照组(P<0.05);干预组BMI为(21.83±4.44)kg/m^(2),对照组为(19.64±3.16)kg/m^(2),差异有统计学意义(P<0.05);炎症指标方面,干预组CRP水平为(35.71±27.77)mg/L,对照组为(56.78±51.22)mg/L,差异有统计学意义(P<0.05);干预组IL-6水平为(30.20±24.47)pg/mL,对照组为(76.18±54.36)pg/mL,差异有统计学意义(P<0.05)。结论:分段式肠内营养联合消化液回输,有利于改善病人的营养状况、减轻炎症反应、降低肠内营养不耐受发生率、减少总住院时间。

Objective:To study the effect of segmented enteral nutrition combined with fistuloclysis on improving the nutritional status of patients with severe intestinal fistula,to explore the impact of nutritional support methods on the recovery of severe intestinal fistula,and to provide nursing experience for patients with severe intestinal fistula.Methods:96 patients with severe intestinal fistulas complicated by multiple fistulas admitted to the intensive care unit of Research Institute of General Surgery from February 2023 to August 2023 were selected.According to the nutritional support method,they were divided into intervention group(n=47)and control group(n=49).The intervention group used segmented enteral nutrition combined with fistuloclysis,and the control group only used segmented enteral nutrition.After 14 days of enteral nutrition intervention,the nutritional status of the two groups was compared,such as BMI,serum albumin levels,total protein levels,and hemoglobin levels;inflammation levels,such as serum C-reactive protein(CRP)levels,interleukin-6(IL-6),enteral Incidence of nutritional intolerance symptoms,prognosis such as total ICU length of stay,total hospitalization costs,etc.Results:After 14 days intervention,the serum total protein and hemoglobin of the intervention group were(71.55±7.00)g/L and(106.64±15.59)g/L,which were significantly higher than those of the control group(P<0.05).The BMI of the intervention group was(21.83±4.44)kg/m^(2),and BMI in the control group was(19.64±3.16)kg/m^(2).The difference was statistically significant(P<0.05).The CRP level in the intervention group was(35.71±27.77)mg/L,which was significantly lower than that in the control group[(56.78±51.22)mg/L,P<0.05].The IL-6 level in the intervention group was(30.20±24.47)pg/mL,which was also significantly lower than that in the control group[(76.18±54.36)pg/mL,P<0.05].Conclusion:Segmented enteral nutrition combined with fistuloclysis is beneficial to improving patients'nutritional status,reducing inflammatory reactions,reducing the incidence of enteral nutrition intolerance,and reducing the length of total hospitalization.