中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2012年
12期
843-848
,共6页
宿英英%高岱佺%马联胜%冯焕焕%王琳%张运周%王玲%刘芳%郭秀海%常红%徐敏%范丽梅%张倩
宿英英%高岱佺%馬聯勝%馮煥煥%王琳%張運週%王玲%劉芳%郭秀海%常紅%徐敏%範麗梅%張倩
숙영영%고대전%마련성%풍환환%왕림%장운주%왕령%류방%곽수해%상홍%서민%범려매%장천
卒中%吞咽困难%肠道营养%循证医学%预后
卒中%吞嚥睏難%腸道營養%循證醫學%預後
졸중%탄인곤난%장도영양%순증의학%예후
Stroke%Dysphagia%Enteral nutrition%Guidelines%Outcomes
目的 对急性卒中伴吞咽困难患者实施基于循证医学证据的《神经系统疾病肠内营养支持操作规范共识》,评估医护人员的依从性及对预后的作用.方法 本研究为前瞻性对照研究,收集急性卒中伴吞咽障碍患者200例,根据入院时间先后分为试验组(医护人员经过培训)和对照组(医护人员未经培训),每组各100例,比较医护人员经《神经系统疾病肠内营养支持操作规范共识》强化培训前、后患者肠内营养支持的操作过程和预后.结果 试验组比对照组患者的正确执行率明显提高的项目有营养风险筛查(92.0％,64.0％；x2=22.840)、营养配方选择(80.0％,48.0％；x2=22.220)、营养输注方式(90.0％,18.0％；x2=1.040)和部分营养输注调整(腹胀发生/调整:21/10,6/4;x2=9.634,便秘发生/调整:41/40,57/53;x2=5.122)4项(均P＜0.05),试验组与对照组比较,病死率、不良预后、神经内科重症监护病房停留天数和住院天数差异均无统计学意义,但对照组医院获得性肺炎(67.5％)高于试验组(44.3％),两组比较差异有统计学意义(x2=7.281,P=0.007).两组卡普兰-迈耶生存曲线时序性检验差异无统计学意义.结论 医护人员对急性卒中伴吞咽障碍患者实施基于循证医学证据的肠内营养操作规范的可行性强,强化培训后可明显提高正确执行率,并使医院获得性肺炎发病率下降.
目的 對急性卒中伴吞嚥睏難患者實施基于循證醫學證據的《神經繫統疾病腸內營養支持操作規範共識》,評估醫護人員的依從性及對預後的作用.方法 本研究為前瞻性對照研究,收集急性卒中伴吞嚥障礙患者200例,根據入院時間先後分為試驗組(醫護人員經過培訓)和對照組(醫護人員未經培訓),每組各100例,比較醫護人員經《神經繫統疾病腸內營養支持操作規範共識》彊化培訓前、後患者腸內營養支持的操作過程和預後.結果 試驗組比對照組患者的正確執行率明顯提高的項目有營養風險篩查(92.0％,64.0％；x2=22.840)、營養配方選擇(80.0％,48.0％；x2=22.220)、營養輸註方式(90.0％,18.0％；x2=1.040)和部分營養輸註調整(腹脹髮生/調整:21/10,6/4;x2=9.634,便祕髮生/調整:41/40,57/53;x2=5.122)4項(均P＜0.05),試驗組與對照組比較,病死率、不良預後、神經內科重癥鑑護病房停留天數和住院天數差異均無統計學意義,但對照組醫院穫得性肺炎(67.5％)高于試驗組(44.3％),兩組比較差異有統計學意義(x2=7.281,P=0.007).兩組卡普蘭-邁耶生存麯線時序性檢驗差異無統計學意義.結論 醫護人員對急性卒中伴吞嚥障礙患者實施基于循證醫學證據的腸內營養操作規範的可行性彊,彊化培訓後可明顯提高正確執行率,併使醫院穫得性肺炎髮病率下降.
목적 대급성졸중반탄인곤난환자실시기우순증의학증거적《신경계통질병장내영양지지조작규범공식》,평고의호인원적의종성급대예후적작용.방법 본연구위전첨성대조연구,수집급성졸중반탄인장애환자200례,근거입원시간선후분위시험조(의호인원경과배훈)화대조조(의호인원미경배훈),매조각100례,비교의호인원경《신경계통질병장내영양지지조작규범공식》강화배훈전、후환자장내영양지지적조작과정화예후.결과 시험조비대조조환자적정학집행솔명현제고적항목유영양풍험사사(92.0％,64.0％；x2=22.840)、영양배방선택(80.0％,48.0％；x2=22.220)、영양수주방식(90.0％,18.0％；x2=1.040)화부분영양수주조정(복창발생/조정:21/10,6/4;x2=9.634,편비발생/조정:41/40,57/53;x2=5.122)4항(균P＜0.05),시험조여대조조비교,병사솔、불량예후、신경내과중증감호병방정류천수화주원천수차이균무통계학의의,단대조조의원획득성폐염(67.5％)고우시험조(44.3％),량조비교차이유통계학의의(x2=7.281,P=0.007).량조잡보란-매야생존곡선시서성검험차이무통계학의의.결론 의호인원대급성졸중반탄인장애환자실시기우순증의학증거적장내영양조작규범적가행성강,강화배훈후가명현제고정학집행솔,병사의원획득성폐염발병솔하강.
Objective To implement and evaluate evidence-based guidelines for enteral nutrition support in acute stroke patients with dysphagia.Methods This study is a prospective before and after comparison study.Collected 200 acute stroke patients with dysphagia and divided them into test group (trained medical staffs) and control group(untrained medical staffs) equally according to the time order.Two groups of 100 patients were surveyed using a checklist before and after implementation of 10 guidelines about nutrition support.Before the implementation of guidelines,the staffs were enforced training,and summarized regularly.Compliances with guidelines by doctors and nurses were compared,and outcomes of patients were assessed.Results Compared with the control group,the correct implementation of the project significantly improved in the experimental group on nutritional risk screening (92.0％,64.0％; x2 =22.840),nutritional supplements selection (80.0％,48.0％; x2 =22.220),nutrition infusion methods (90％,18％ ; x2 =1.040) and nutrition infusion adjustment (abdominal distension/adjusted:21/10,6/4;x2 =9.634,constipation/adjusted:41/40,57/53 ; x2 =5.122,all P ＜ 0.05).The mortality rate,poor prognosis and length of stay in department of neurology intensive care unit and in hospital were not significant different between the experimental group and the control group.The incidence of hospital-acquired pneumonia was significantly lower in the experimental group (44.3％) than that in the control group (67.5％,x2 =7.281,P =0.007),but other patient outcomes were unaffected significantly.Conclusion Implementation of evidence-based guidelines for enteral nutrition support in acute stroke patients with dysphagia is associated with improvements in clinical quality and selected patient outcomes.
