阶梯式精细化饮食管理对肝硬化并发消化道出血患者饮食控制的影响

Effects of stepwise and fine-grained dietary management on the diet control of liver cirrhosis patients complicated with gastrointestinal hemorrhage

目的：探讨阶梯式精细化饮食管理对肝硬化并发消化道出血患者开放饮食后饮食干预的影响。方法将80例肝硬化并发消化道出血患者采用随机数字表法随机分为试验组41例及对照组39例。试验组予阶梯式精细化饮食管理，对照组予常规饮食干预。在入院时、开放饮食时、出院时、出院2个月，监测2组患者饮食符合率、饮食知识掌握情况、营养不良风险的变化。在出院后1年，监测2组患者再出血发生率的变化。结果肝硬化并发消化道出血患者中，Child-Pugh C级患者的营养不良风险率较Child-Pugh B级者高（Z=-4.3，P＜0.05），文化程度低者较文化程度高者高（r=-0.453，P＜0.05）。试验组的饮食知识掌握度在出院时为80（70，84）分，明显优于对照组的52（42，64）分，饮食符合率在出院2个月为86（76，91）%，显著高于对照组的53（46，57）%，营养风险评分在出院2个月为1（1，2）分，显著低于对照组的2（1，3）分，1年内再次出血发生率为14.6%（6/41），显著小于对照组的35.9%（14/39），2组比较差异有统计学意义（χ2=4.266～51.232，均P＜0.05）。结论阶梯式精细化饮食管理能提高患者的饮食知识掌握率、饮食符合率及营养状况，降低再次出血的发生，值得在肝硬化并发消化道出血患者的临床护理中推广及应用。

Objective To evaluate the effects of stepwise and fine-grained dietary management on the diet control of liver cirrhosis patients complicated with gastrointestinal hemorrhage. Methods Eighty liver cirrhosis patients complicated with gastrointestinal hemorrhage were assigned to experimental group (41 cases) and control group(39 cases) by random digits table method. The patients in experimental group were treated with stepwise and fine-grained dietary management and the patients in control group were given conventional dietary treatments. The compliance diet, mastery of nutrition knowledge, malnutrition risk at admission, intake food, discharge and 2 months after discharge between two groups were monitored. The incidence of rebleeding was tracked after 1 year of discharge. Results The incidence of malnutrition risk in Child-Pugh class C was higher than that in Child-Pugh class B( Z=-4.3, P<0.05 ) . The incidence of malnutrition risk in patients with high education level was lower than that in patients with lower education( r=-0.453, P<0.05 ). The experimental group significantly outperformed control group in mastery of nutrition knowledge at discharge:80(70, 84) points vs. 52(42, 64) points, in compliance diet and malnutrition risk after 2 months after discharge:86(76, 91)%vs. 53(46,57)%, 1(1, 2) points vs. 2(1,3) points, the rebleeding rate in experimental group was significantly less than that in control group within 1 year after discharge 14.6%(6/41) vs. 35.9%(14/39), and the differences were statistically significant between two groups ( χ2 = 4.226- 51.232, all P < 0.05 ). Conclusions Stepwise and fine-grained dietary management can improve the mastery of nutrition knowledge, compliance diet and nutritional&nbsp;status, and reduce the occurrence of rebleeding, worth popularizing further in clinical care of liver cirrhosis patients complicated with gastrointestinal hemorrhage.