神经疾病肠内营养支持操作规范的依从性与有效性  

Compliance and effectiveness of the clinical practice guidelines for enteral nutrition support in acute stroke patients with dysphagia

作　　者：宿英英[1] 高岱佺[1] 马联胜[1] 冯焕焕[1] 王琳[1] 张运周[1] 王玲[1] 刘芳[1] 郭秀海[1] 常红[1] 徐敏[1] 范丽梅[1] 张倩[1] 

机构地区：[1]首都医科大学宣武医院神经内科,北京100053

出　　处：《中华神经科杂志》2012年第12期843-848,共6页Chinese Journal of Neurology

摘　　要：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％；χ2=22．840）、营养配方选择（80．0％，48．0％；χ2=22．220）、营养输注方式（90．0％，18．0％；χ2=1．040）和部分营养输注调整（腹胀发生／调整：21／10，6／4；χ2=9．634，便秘发生／调整：41／40，57／53；χ2=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（χ2=7．281，P=0．007）。两组卡普兰一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。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%; χ2= 22. 840）, nutritional supplements selection （80. 0%, 48. 0% χ2 = 22. 220）, nutrition infusion methods , χ2 （90% 18% ; = 1. 040） and nutrition infusion adjustment （abdominal distension/adjusted： 21/10, 6/4; χ2 = 9. 634, constipation/adjusted ： 41/40, 57/53 ; χ2 = 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%, χ2 = 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.

关 键 词：卒中 吞咽困难 肠道营养 循证医学 预后 

分 类 号：R741[医药卫生—神经病学与精神病学]