普通外科重症加强护理病房早期蛋白质摄入量的现状及阻碍和促进因素分析:混合研究  

Investigation of protein intake status and analysis of influencing factors in general surgery intensive care unit patients:A mixed-method study

作　　者：李嘉琪 姚红林 叶向红 LI Jiaqi;YAO Honglin;YE Xianghong(Department of General Surgery,Eastern Theater General Hospital of Chinese People’s Liberation Army,Nanjing 210001,P.R.China)

机构地区：[1]中国人民解放军东部战区总医院普通外科,南京210001

出　　处：《中国普外基础与临床杂志》2025年第3期347-353,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：军事医学创新工程(项目编号:18CXZ040)。

摘　　要：目的调查普通外科重症加强护理病房(intensive care unit,ICU)患者的蛋白质摄入量,并从医护人员角度分析影响蛋白质摄入量的阻碍和促进因素。方法本研究采用混合研究方法(量性研究结合质性研究)。量性研究分析普通外科ICU患者的蛋白质摄入情况,质性研究通过半结构式访谈对医护人员对蛋白质摄入情况的观点进行分析。量性研究分析32个研究变量,以研究变量的10倍估算样本量;质性研究采用最大差异策略进行抽样,样本量以资料分析中不再有新主题出现为准。采用多重线性回归分析影响蛋白质摄入达标的风险因素,检验水准α=0.05。结果量性研究共纳入459例患者,蛋白质摄入量为(0.739±0.552)g/(kg·d),其中蛋白质摄入量1.2~2.0 g/(kg·d)者90例(19.6%),≥2.0 g/(kg·d)者11例(2.4%),<1.2 g/(kg·d)者358例(78.0%)。多重线性回归分析发现,男性、随体质量指数增大、入ICU时血糖水平越高、开始肠内营养时间早(≤48 h)、鼻肠管置管及单纯肠内营养喂养是影响蛋白质摄入量的风险因素。质性研究中,对访谈资料进行分析提炼后整合出3个对蛋白质摄入有关的主题,即基础设施不完善、医护人员自身因素及患者因素。结论本研究结果提示,普通外科ICU患者蛋白质摄入情况与指南要求相比有较大差距,根据影响蛋白质摄入量风险因素重点关注与此相关的患者群体;日后需通过培训、构建规范化蛋白质补充流程、加强对患者宣教,以提高蛋白质补充效率,改善患者营养状况。Objective To investigate the protein intake of patients in the general surgery intensive care unit(ICU)and to analyze the factors,both hindering and facilitating,that affecting protein intake from the perspective of healthcare professionals.Methods A mixed-methods approach was used in this study,including a quantitative study and a qualitative study.The quantitative study was use to assess the protein intake in the ICU patients.The qualitative study was used to analyze the perspectives of healthcare professionals via semi-structured interviews.In the quantitative study,32 variables were analyzed,and the sample size was estimated to be 10 times the number of study variables.The qualitative study employed the maximum difference sampling strategy,with the sample size determined by data saturation.The multiple linear regression was used to identify the risk factors affecting protein intake achievement,with a significance level ofα=0.05.Results The quantitative study included 459 patients,with a protein intake of(0.739±0.552)g/(kg·d).Of the patients,90(19.6%)had a protein intake of 1.2-2.0 g/(kg·d),11(2.3%)had 2.0 g/(kg·d)or more,and 358(78.0%)had less 1.2 g/(kg·d).The multiple linear regression analysis identified several risk factors influencing protein intake attainment,including male,higher body mass index,elevated blood glucose levels upon ICU admission,early initiation of enteral nutrition(≤48 h),nasoenteric tube placement,and the only use of enteral nutrition feedings.In the qualitative study,three key themes relevant protein intake attainment were identified from the interviews:inadequate infrastructure,healthcare workers’factors,and patient-related factors.Conclusions The findings of this study suggest a substantial gap between the protein intake of general surgical ICU patients and the guideline-recommended intake.The study highlights patient groups at risk for inadequate protein intake based on identified risk factors.Future efforts should focus on improving the efficiency of protein supplementati

关 键 词：肠内营养 蛋白质补充 普通外科重症加强护理病房 影响因素 混合研究 

分 类 号：R47[医药卫生—护理学]