严重创伤患者疾病轨迹导向的营养管理方案构建与应用研究  

Construction and application of a nutritional management program based on the disease trajectory for severely injured patients

作　　者：黄晓霞[1] 唐佳迎 江利冰[2] 高梦珂 朱梦婷 吴龙琴 封秀琴[1] HUANG Xiaoxia;TANG Jiaying;JIANG Libing;GAO Mengke;ZHU Mengting;WU Longqin;FENG Xiuqin(Department of Nursing,Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,310000,China;不详)

机构地区：[1]浙江大学医学院附属第二医院护理部,杭州市310000 [2]浙江大学医学院附属第二医院急诊医学科,杭州市310000

出　　处：《中华急危重症护理杂志》2025年第4期414-420,共7页Chinese Journal of Emergency and Critical Care Nursing

基　　金：浙江省医药卫生科技计划(2023KY724)。

摘　　要：目的构建严重创伤患者疾病轨迹导向的营养管理方案并探究其应用效果。方法采用非同期前后对照研究,便利选取2023年4月—6月杭州市某三级甲等医院收治的严重创伤患者作为试验组,2023年1月—3月的严重创伤患者作为对照组。试验组实施严重创伤患者疾病轨迹导向的营养管理方案,对照组实施目标导向的早期营养管理方案。比较两组患者营养相关指标。结果最终纳入试验组84例,对照组87例。试验组启动肠内营养支持时间(t=2.335,P=0.017)、7 d内喂养中断次数(Z=3.194,P=0.024)及喂养中断时长(Z=3.865,P<0.001)、入科72 h内血糖变异系数(t=-2.432,P=0.016)及胰岛素总用量(t=-4.664,P=0.035)、喂养不耐受发生率(χ^(2)=5.554,P=0.021)均低于对照组;7 d目标能量达标率(χ^(2)=7.875,P=0.009)、血清前白蛋白(t=4.129,P=0.016)均高于对照组;人体成分分析结果显示,试验组的相位角高于对照组(t=1.976,P=0.040);两组去脂体重、机械通气时间、ICU住院时间、病情好转差异无统计学意义(P>0.05)。结论该方案能提高肠内营养的落实及执行质量,缩短肠内营养开始时间,提高目标热量达标率的同时改善严重创伤患者营养状况,促进患者康复。Objective To construct a nutritional management program based on the disease trajectory for severely injured patients and explore its application effects.Methods A non-synchronous before-and-after control study was conducted.Severely injured patients admitted to a tertiary class A hospital in Hangzhou from April to June 2023 were conveniently selected as the experimental group,and those admitted from January to March 2023 as the control group.The control group received a goal-directed early nutritional management program,while the experimental group received a nutritional management program based on the disease trajectory of severely injured patients.Nutritional-related indicators were compared between the two groups.Results A total of 84 patients were included in the experimental group and 87 in the control group.After the intervention,the experimental group had shorter initiation time for enteral nutrition support(t=2.335,P=0.017),fewer feeding interruption episodes within 7 d(Z=3.194,P=0.024),shorter feeding interruption duration(Z=3.865,P<0.001),lower blood glucose variability coefficient within 72 h(t=-2.432,P=0.016),and lower total insulin dosage(t=-4.664,P=0.035),and a lower incidence of feeding intolerance(χ^(2)=5.554,P=0.021)compared to the control group.The 7 d target energy achievement rate(χ^(2)=7.875,P=0.009)and serum prealbumin levels(t=4.129,P=0.016)were higher in the experimental group.Body composition analysis showed that the phase angle of the experimental group was higher than that of the control group(t=1.976,P=0.040).There were no statistically significant differences in lean body mass,mechanical ventilation time,ICU length of stay,or improvement in the condition.Conclusion The program improve the implementation and quality of enteral nutrition,shorten the time to start enteral nutrition,enhance the target caloric achievement rate,and improve the nutritional status of severely injured patients,promoting their recovery.

关 键 词：严重创伤 疾病轨迹 精准营养 护理 

分 类 号：R473.6[医药卫生—护理学]