集束化护理对出血性脑卒中患者肠内营养不耐受干预的效果研究  

Effects of care bundles on reducing the enteral feed intolerance in patients with hemorrhagic stroke

作　　者：李旻露 樊朝凤 段丽娟[1] 王聪[2] 蒋艳[3] LI Minlu;FAN Chaofeng;DUAN Lijuan;WANG Cong;JIANG Yan(Department of Neurosurgery,West China Hospital,Sichuan University/West China School of Nursing,Sichuan University,Chengdu,610041,China)

机构地区：[1]四川大学华西医院神经外科/四川大学华西护理学院,成都市610041 [2]四川大学华西医院循证护理中心,成都市610041 [3]四川大学华西医院护理部,成都市610041

出　　处：《中国护理管理》2023年第12期1774-1779,共6页Chinese Nursing Management

基　　金：四川省科技计划重点研发项目(2023YFS0049);中国医学科学院医学与健康科技创新工程项目(2021-I2M-C&T-A-023)。

摘　　要：目的:评价基于循证的出血性脑卒中患者肠内营养集束化护理措施在降低喂养不耐受发生率中的应用效果,为出血性脑卒中肠内营养患者的精细化管理提供参考。方法:根据现存问题,检索证据,形成4项集束化护理措施(以护士为主导的多学科肠内营养管理;基于胃肠动力指导喂养途径选择和喂养速度调整;提供个体化肠内营养制剂;采用腹部按摩、腹部热敷促进胃肠动力)。选取某三级甲等医院2020年12月至2021年6月收治的出血性脑卒中肠内营养患者为干预组(n=69),实施集束化护理,选取2020年4月—10月收治的患者为对照组(n=70),实施常规肠内营养护理,分析两组患者喂养不耐受发生率、营养管理相关指标的变化。结果:干预组喂养不耐受发生率显著低于对照组(P<0.05),营养管理相关指标优于对照组(P<0.05)。结论:应积极推广集束化护理措施,以改善出血性脑卒中患者肠内营养喂养不耐受症状和营养状态。Objective:To analyze the implementation effects of evidence-based care bundles in reducing the incidence of feeding intolerance in patients with hemorrhagic stroke,which will provide ideas for the meticulous management of enteral nutrition patients with hemorrhagic stroke.Methods:Four evidence-based care bundle strategies were formed,including establishing a nurse-led multidisciplinary enteral nutrition management team,controlling feeding pathways and speeds based on gastrointestinal dynamics,providing individual enteral nutrition preparation,and using abdominal massage and hot compress to promote gastrointestinal motility.Patients with hemorrhagic stroke admitted to a tertiary hospital from December 2020 to June 2021 were selected as experimental group(n=69)and compared them with patients(n=70)admitted from April to October 2020,to analyze the changes in feeding intolerance and nutritional status.Results:The incidence of feeding intolerance in the intervention group was significantly lower than that in the control group,and the nutritional status were significantly better than that in the control group(all P<0.05).Conclusion:Care bundles should be actively promoted to reduce enteral feed intolerance for patients with hemorrhagic stroke,improving their nutrition status.

关 键 词：出血性脑卒中 喂养不耐受 肠内营养 集束化护理 循证实践 护理质量 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]