本文選題：夜間加餐 + 慢加急性肝功能衰竭　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：研究目的(1)在了解慢加急性肝功能衰竭患者的營養(yǎng)風(fēng)險的基礎(chǔ)上給予夜間加餐,觀察對患者營養(yǎng)狀態(tài)、肝功能恢復(fù)、營養(yǎng)風(fēng)險、并發(fā)癥發(fā)生率的影響,以期減少患者并發(fā)癥,提高生活質(zhì)量,改善臨床結(jié)局和預(yù)后;(2)為慢加急肝功能衰竭患者尋找一種價格低廉并有效的加餐模式;(3)為臨床實(shí)踐中實(shí)施有效的護(hù)理措施、促進(jìn)慢加急肝功能衰竭患者的康復(fù)提供理論依據(jù)。研究方法本研究選取2015年12月到2016年6月進(jìn)入鄭州市某三級綜合醫(yī)院感染科就診的101例慢加急性肝功能衰竭患者,分為夜間加餐研究組和對照組。用拋硬幣法隨機(jī)將感染一病區(qū)患者分為對照組,接受一般內(nèi)科綜合治療+日間營養(yǎng)干預(yù);感染二病區(qū)患者為研究組,在一般內(nèi)科綜合治療+日間營養(yǎng)干預(yù)的基礎(chǔ)上加夜間加餐,加餐內(nèi)容:小面包40g+酸奶100ml。加餐時間為睡前半小時或晚9-10點(diǎn)加餐,觀察周期為入院24小時后至住院一個月。兩組均在入院48小時內(nèi),入院一周后,入院一月后記錄營養(yǎng)相關(guān)指標(biāo)。包括一般情況調(diào)查表、NRS-2002評分、實(shí)驗(yàn)室指標(biāo):肝功能(白蛋白、前白蛋白);特種蛋白(轉(zhuǎn)鐵蛋白)、人體測量學(xué)指標(biāo):體重、體重指數(shù)(BMI)、上臂肌圍(MAMC)、肱三頭肌皮褶厚度(TSF)、入院和出院時患者Child-Pugh評分、兩組患者并發(fā)癥、住院時間、住院期間輸注白蛋白量以及患者疾病轉(zhuǎn)歸情況。本研究所有數(shù)據(jù)資料進(jìn)行統(tǒng)計學(xué)分析均使用SPSS 21.0,其中檢驗(yàn)水準(zhǔn)定為α=0.05。統(tǒng)計分析結(jié)果均用x±s表示。主要運(yùn)用包括獨(dú)立樣本t檢驗(yàn)、重復(fù)測量的方差分析、χ2檢驗(yàn)及稚和檢驗(yàn)等統(tǒng)計學(xué)方法來完成數(shù)據(jù)的統(tǒng)計分析。結(jié)果1.本研究入組病例共120例,其中干預(yù)組及對照組均為60例,研究過程中,因肝移植手術(shù)、病情加重、死亡等原因脫落19例,樣本流失率為15.8%。共有101例患者完成整個干預(yù)過程,干預(yù)組50例,對照組51例。干預(yù)前兩組患者干預(yù)前一般情況資料處于均衡狀態(tài),統(tǒng)計學(xué)分析顯示兩組差異無統(tǒng)計學(xué)意義(P0.05);2.兩組患者干預(yù)前后營養(yǎng)風(fēng)險NRS-2002評分的比較:干預(yù)組患者干預(yù)前的NRS-2002評分為(1.60±0.81)分,對照組評分為(1.75±0.74)分,統(tǒng)計學(xué)分析顯示兩組間差異沒有統(tǒng)計學(xué)意義(P0.05)。干預(yù)一個月后,干預(yù)組的NRS-2002評分較對照組低,兩組相比差異有統(tǒng)計學(xué)意義(P0.05)。3.干預(yù)前后兩組患者Child-Pugh評分的比較:干預(yù)前干預(yù)組患者ChildPugh評分為(9.54±0.76)分,對照組為(9.73±1.02)分,統(tǒng)計學(xué)分析顯示兩組間差異沒有統(tǒng)計學(xué)意義(P0.05)。干預(yù)一個月后,干預(yù)組的Child-Pugh評分較對照組低,兩組相比差異有統(tǒng)計學(xué)意義(P0.05);4.干預(yù)前后兩組患者營養(yǎng)相關(guān)的身體測量指標(biāo)的比較:兩組患者的皮褶厚度值在干預(yù)前,干預(yù)一周、干預(yù)一個月相比均沒有統(tǒng)計學(xué)差異(P0.05);兩組患者的上臂圍值在干預(yù)前,干預(yù)一周、相比均沒有統(tǒng)計學(xué)差異(P0.05),干預(yù)一個月后,兩組相比差異有統(tǒng)計學(xué)意義(P0.05);兩組患者的體重值在干預(yù)前,干預(yù)一周、相比均沒有統(tǒng)計學(xué)差異(P0.05),隨著時間的延長,在干預(yù)一個月后干預(yù)組的體重值要明顯高于對照組,有統(tǒng)計學(xué)差異(P0.05);BMI值在干預(yù)前,干預(yù)一周、干預(yù)一個月相比差異無統(tǒng)計學(xué)意義(P0.05)。5.兩組患者干預(yù)前后營養(yǎng)相關(guān)的生化指標(biāo)的比較:兩組患者的血清白蛋白值在干預(yù)前,干預(yù)一周后相比均沒有統(tǒng)計學(xué)差異(P0.05),隨著時間的延長,在干預(yù)一個月后干預(yù)組的血清白蛋白值要明顯高于對照組,有統(tǒng)計學(xué)差異(P0.05);兩組患者的前白蛋白值在干預(yù)前,干預(yù)一周后相比沒有統(tǒng)計學(xué)差異(P0.05),干預(yù)一個月后兩組前白蛋白值有統(tǒng)計學(xué)差異(P0.05);兩組患者的轉(zhuǎn)鐵蛋白值在干預(yù)前,干預(yù)一周后相比均沒有統(tǒng)計學(xué)差異(P0.05),干預(yù)一個月后兩組轉(zhuǎn)鐵蛋白值有統(tǒng)計學(xué)差異(P0.05)。6.兩組患者住院期間臨床結(jié)局指標(biāo)的比較:干預(yù)后發(fā)現(xiàn):住院期間兩組患者的并發(fā)癥發(fā)生率有統(tǒng)計學(xué)差異(P0.05);感染性相關(guān)并發(fā)癥的差異沒有統(tǒng)計學(xué)意義(P0.05);非感染性相關(guān)并發(fā)癥的發(fā)生率有統(tǒng)計學(xué)差異(P0.05)。干預(yù)后對兩組患者住院期間輸注白蛋白量和住院時間進(jìn)行組間比較,兩組患者住院期間輸注白蛋白的量沒有統(tǒng)計學(xué)意義(P0.05),兩組患者住院時間有統(tǒng)計學(xué)差異(P0.05);干預(yù)后對兩組患者的臨床結(jié)局進(jìn)行兩兩比較,兩組患者臨床轉(zhuǎn)歸,差異沒有統(tǒng)計學(xué)意義(P0.05)。結(jié)論1.本研究證明營養(yǎng)風(fēng)險在慢加急性肝功能衰竭患者中廣泛存在,需要在臨床工作中引起關(guān)注并及時給予治療;2.在常規(guī)治療護(hù)理的基礎(chǔ)上,夜間加餐可以有效降低慢加急性肝功能衰竭患者的NRS-2002評分、Child-Pugh評分;3.夜間加餐在短期內(nèi)改善患者BMI、皮褶厚度等方面效果不明顯,但在干預(yù)一月后改善血清白蛋白、前白蛋白、轉(zhuǎn)鐵蛋白等方面效果明顯;4.夜間加餐對于住院期間兩組患者的并發(fā)癥發(fā)生率有影響,尤其體現(xiàn)在非感染性相關(guān)并發(fā)癥方面;夜間加餐對兩組患者住院期間輸注白蛋白的量沒有影響;住院期間短期的夜間加餐對患者臨床轉(zhuǎn)歸并不能帶來明顯積極的影響。
[Abstract]:Objective (1) to give meals at night based on the nutritional risk of patients with chronic acute liver failure and to observe the effects of nutritional status, liver function recovery, nutritional risk, and incidence of complications on patients, in order to reduce the complications, improve the quality of life, improve the clinical outcome and prognosis, and (2) for patients with chronic acute liver failure. To find a cheap and effective feeding pattern; (3) to provide a theoretical basis for the implementation of effective nursing measures in clinical practice and to promote the rehabilitation of patients with slow and acute liver failure. This study selected 101 cases of chronic acute liver failure from December 2015 to June 2016, which entered the Department of infection in a three level general hospital in Zhengzhou. The exhausted patients were divided into the night meal study group and the control group. The patients were randomly divided into the control group with the coin tossing method. The general internal medicine comprehensive treatment plus daytime nutrition intervention was accepted. The patients infected with the two disease area were the research group. At the basis of the general internal medicine comprehensive treatment + daytime nutrition intervention, the meal was added at night, and the content of the meal was 40g+ acid. Milk 100ml. plus meal time was half an hour before bedtime or 9-10 o'clock at night. The observation period was 24 hours after admission to one month in hospital. The two groups were all within 48 hours of admission to hospital. After admission one week, the nutrition related indexes were recorded after one month, including general situation questionnaire, NRS-2002 score, laboratory index, liver function (albumin, prealbumin) and special egg. White (transferrin), anthropometric indicators: weight, body mass index (BMI), upper arm muscle circumference (MAMC), brachial triceps skin fold thickness (TSF), Child-Pugh score of patients at admission and discharge, two groups of patients' complications, hospitalization time, inpatient infusion albumin, and patient's prognosis. All data of this study were statistically analyzed. SPSS 21 was used, and the results of the test water were determined to be alpha =0.05. statistical analysis results using X + s. The main use of independent sample t test, repeated measurement of variance analysis, chi 2 test and juvenile test and other statistical methods to complete the statistical analysis of the data. Results 1. cases were enrolled in a total of 120 cases, of which the intervention group and the control group were 60 In the course of the study, 19 cases were lost due to liver transplantation, aggravation and death. The loss rate of the sample was 15.8%., 101 patients completed the whole intervention process, 50 cases in the intervention group and 51 cases in the control group. Before intervention, the general information in the two groups was in a balanced state, and the statistical analysis showed that there was no statistical significance in the two groups (P0.0 5); 2. and two groups of patients before and after intervention in the nutritional risk NRS-2002 score: the intervention group before the intervention of the NRS-2002 score was (1.60 + 0.81) scores, the control group was (1.75 + 0.74) scores, statistical analysis showed that there was no significant difference between the two groups (P0.05). After one month, the intervention group's NRS-2002 score was lower than the control group, two groups compared to the comparison. The difference was statistically significant (P0.05) the comparison of the Child-Pugh scores in the two groups of patients before and after.3. intervention: the ChildPugh score of the intervention group was (9.54 + 0.76), the control group was (9.73 + 1.02), and the statistical analysis showed that there was no statistical difference between the two groups (P0.05). After one month intervention, the Child-Pugh score of the intervention group was lower than the control group. The difference between the two groups was statistically significant (P0.05); 4. in the two groups of patients before and after intervention, the comparison of physical measurement indexes related to nutrition: the skin fold thickness of the two groups before intervention, intervention for one week compared to one month, there was no statistical difference (P0.05); the upper arm circumference of the two groups was not statistically significant before intervention, compared with no statistics. The difference (P0.05), after one month, the difference between the two groups was statistically significant (P0.05). The weight value of the two groups was not statistically significant before intervention, and there was no statistical difference (P0.05). The weight value of the intervention group was significantly higher than that of the control group after one month of intervention (P0.05), and the BMI value was before the intervention, The intervention of one week, intervention for one month compared with the difference of the difference between the two groups of.5. two patients before and after intervention, the comparison of the biochemical indexes of nutrition related before and after intervention: the serum albumin value of the two groups was not statistically significant before intervention one week after intervention (P0.05), and with the prolonged period of intervention, the serum albumin of the intervention group after one month intervened. The values of the two groups were statistically different (P0.05). Before intervention, the value of prealbumin was not statistically significant (P0.05) before intervention (P0.05). The value of prealbumin was statistically different (P0.05) after one month intervention (P0.05), and the value of transferrin in the two groups was not statistically significant before intervention for one week. Difference (P0.05), after one month, two groups of transferrin values were statistically different (P0.05) in group.6. two patients, the comparison of clinical outcomes during hospitalization: after intervention, the incidence of complications in two groups of patients was statistically significant (P0.05); there was no statistical significance (P0.05) for the difference between infection related and onset (P0.05); The incidence of complications was statistically different (P0.05). After the two groups of patients, the amount of albumin infusion and the time of hospitalization were compared between the two groups. The amount of albumin infusion in the two groups was not statistically significant (P0.05), and the time of hospitalization in the two groups was statistically different (P0.05); the clinical outcome of the two groups of patients after the intervention was of the clinical outcome. The difference was not statistically significant (P0.05) in the clinical outcome of the two groups (P0.05). Conclusion the 1. study showed that the nutritional risk existed widely in the patients with slow and acute liver failure, requiring attention and timely treatment in the clinical work; 2. on the basis of routine treatment care, the night meal could effectively reduce the slow speed. NRS-2002 score and Child-Pugh score for patients with HF; 3. night meals were not effective in improving patients' BMI and skin fold thickness in the short term, but the effect of improving serum albumin, prealbumin and transferrin was obvious after a month of intervention, and 4. night meals had a shadow in the incidence of complications in two groups of patients during hospitalization. Sounded, especially in non infectious complications; nocturnal meals have no effect on the amount of albumin infusion in two groups of patients during hospitalization, and the short-term nighttime meals during hospitalization do not have a significant positive impact on the patient's clinical outcome.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 高飛;張衛(wèi)青;梁首勤;曾艷麗;李翔;潘寒寒;;血清白蛋白、前白蛋白和轉(zhuǎn)鐵蛋白在評價慢性肝衰竭患者營養(yǎng)支持中的應(yīng)用[J];實(shí)用醫(yī)學(xué)雜志;2017年04期

2 Sara Blasco-Algora;José Masegosa-Ataz;María Luisa Gutiérrez-García;Sonia Alonso-López;Conrado M Fernández-Rodríguez;;Acute-on-chronic liver failure:Pathogenesis,prognostic factors and management[J];World Journal of Gastroenterology;2015年42期

3 趙永恒;周文杰;陳剛;胡宗強(qiáng);;慢加急性肝衰竭[J];中國普外基礎(chǔ)與臨床雜志;2015年10期

4 張雅楠;丁虹;杜玉萍;;回顧性膳食調(diào)查輔助工具的應(yīng)用現(xiàn)狀與評價方法[J];職業(yè)與健康;2015年09期

5 王艷麗;黎環(huán);;乙型肝炎肝衰竭患者預(yù)后影響因素研究[J];胃腸病學(xué)和肝病學(xué)雜志;2014年10期

6 沈秋月;李國宏;;不同營養(yǎng)評價方法對肝衰竭患者營養(yǎng)狀況評價比較[J];大家健康(學(xué)術(shù)版);2014年19期

7 向冬梅;;營養(yǎng)支持治療在慢性肝功能衰竭病中效果觀察[J];中國衛(wèi)生產(chǎn)業(yè);2014年28期

8 王春艷;紀(jì)冬;陳國鳳;;肝硬化營養(yǎng)不良的評價及治療的研究進(jìn)展[J];中國肝臟病雜志(電子版);2014年03期

9 阮承蘭;張駿飛;宋海燕;董靜;陳照林;陳曦;劉波;陳從新;;肝衰竭預(yù)后影響因素的Logistic回歸分析[J];中華疾病控制雜志;2014年06期

10 朱鳴;徐列明;;肝硬化患者常用的營養(yǎng)風(fēng)險評價方法與比較[J];臨床肝膽病雜志;2013年05期

，

本文編號：1886916