根因分析法下护士主导的营养支持干预方案在重型颅脑损伤患者中的应用

Application of nurse-led nutrition support intervention program under rootcause analysis in patients with severe craniocerebral injury

目的探究根因分析法下护士主导的营养支持干预方案在重型颅脑损伤患者中的应用对患者肠内营养中断的预防效果。方法本研究采用便利抽样法选取2023年1月-2024年3月在空军军医大学第一附属医院神经外科重症监护室治疗的126例重型颅脑损伤患者为研究对象,按照就诊时间,将2023年1-5月的42例患者作为对照组,将2023年6月-2024年3月的84例患者作为观察组。对照组采用常规肠内营养支持流程,观察组在常规护理基础上组建护士主导的营养支持团队,通过根因分析法制定并实施肠内营养中断预防方案。比较2组患者7 d内肠内营养中断次数、热量达标天数、肠内营养并发症发生率及干预前后营养代谢指标(白蛋白、血红蛋白)差异。结果干预前2组患者营养代谢指标比较,差异均无统计学意义(P>0.05);干预后2组患者营养代谢指标比较,差异有统计学意义(P<0.05);观察组7 d内肠内营养中断次数及7 d内热量达标天数均优于对照组(P<0.05);2组患者肠内营养并发症发生情况比较,除呕吐外,其余均有统计学意义(P<0.05)。结论根因分析法下护士主导的营养支持的干预方案,能够减少重型颅脑损伤患者肠内营养中断次数,增加热量达标天数,改善其营养代谢指标,降低肠内营养并发症发生率。

Objective To explore the preventive effect of nurse-led nutritional support intervention program under root cause analysis on enteral nutrition interruption in patients with severe craniocerebral injury.Methods This study conveniently selected 126 patients with severe craniocranial injury treated in the neurosurgical intensive care unit of our hospital from January 2023 to March 2024 as the study object,42 patients from January to May 2023 as the control group and 84 patients from June 2023 to March 2024 as the observation group according to the treatment time.The control group adopted the routine enteral nutrition support process,and the observation group set up a nurse-led nutrition support team on the basis of routine nursing,and developed and implemented the prevention program of enteral nutrition interruption through root cause analysis.Compare the number of interruptions in enteral nutrition within 7 days,the number of days to reach the standard of calorie intake,the incidence of enteral nutrition complications,and the differences in nutritional metabolism indicators(albumin,hemoglobin)before and after intervention between two groups of patients.Results here was no statistically significant difference in nutritional and metabolic indicators between the two groups of patients before intervention(P>0.05);After intervention,there was a statistically significant difference in nutritional and metabolic indicators between the two groups of patients(P<0.05);The number of interruptions in enteral nutrition within 7 days and the number of days to reach the standard of heat card within 7 days in the observation group were both better than those in the control group(P<0.05);The incidence of enteral nutrition complications in two groups of patients was compared,and except for vomiting,all others had statistical significance(P<0.05).Conclusion The intervention method of nurse-led nutritional support intervention program under root cause analysis can reduce the number of interruptions of enteral nutrition in patients with severe craniocerebral injury,increase the number of days of calories reaching the standard,improve nutritional metabolism indexes,and reduce the incidence of enteral nutritional complications.