急性胰腺炎患者營養(yǎng)篩查及個性化飲食干預(yù)效果研究
發(fā)布時間：2018-07-17 17:21
【摘要】：目的評價急性胰腺炎(Acute Pancreatitis,AP)患者營養(yǎng)狀況,探討個性化飲食干預(yù)對AP患者營養(yǎng)支持效果,為臨床合理開展?fàn)I養(yǎng)支持提供理論依據(jù)。方法選取2015年10月至2016年10月在皖南醫(yī)學(xué)院第一附屬醫(yī)院消化內(nèi)科(41病區(qū)和42病區(qū))住院經(jīng)臨床確診的62例AP患者為研究對象。兩個病區(qū)AP患者是根據(jù)床位隨機入住,將在42病區(qū)住院患者設(shè)為對照組(32例),在41病區(qū)住院患者設(shè)為實驗組(30例);對照組給予常規(guī)的營養(yǎng)支持治療和護理,實驗組在常規(guī)營養(yǎng)支持治療護理基礎(chǔ)上,根據(jù)營養(yǎng)風(fēng)險評估情況,制定個性化飲食方案進行護理干預(yù)。(1)入院時收集兩組AP患者的一般資料;(2)兩組患者分別在入院時、住院第3天和出院時進行如下資料收集(1)采用通用型營養(yǎng)不良篩查工具(Malnutrition Universal Screening Tool,MUST)進行營養(yǎng)狀況評估;(2)采用疾病嚴重程度(Bedside Index for Severity in Acute Pancreatitis,BISAP)評分表評估患者疾病嚴重程度;(3)采用長海痛尺評價其腹痛程度;(4)預(yù)測兩組患者能量消耗值(Predictable Resting Energy Expenditure,PREE)、實際能量攝入值(Actual Energy Intake,AEI)及總熱量達標(biāo)情況;(5)監(jiān)測血生化指標(biāo),如血淀粉酶(Amylase,MY)、血脂肪酶(Lipase,LIP)、血清白蛋白(Albumin,ALB)、血清前白蛋白(Prealbumin,PA)、血清轉(zhuǎn)鐵蛋白(transferrin,TRF)。(3)測量兩組AP患者入院時和出院時體重、三頭肌皮褶厚度(Triceps Skin Fold,TSF)、上臂圍(Middle Arm Circumference,MAC)、上臂肌圍(Middle Arm Muscles Circumference,MAMC)。(4)觀察兩組AP患者在整個住院期間疾病及營養(yǎng)相關(guān)并發(fā)癥發(fā)生情況。收集的資料采用SPSS18.0統(tǒng)計軟件對數(shù)據(jù)進行統(tǒng)計分析。結(jié)果兩組AP患者在性別、年齡、婚姻狀況、收入、文化程度、宗教信仰、致病原因、腹痛程度、BISAP評分等一般資料方面P0.05,差異無統(tǒng)計學(xué)意義,具有可比性;兩組AP患者入院時MUST得分、PREE、AMY、LIP、TSF、MAC、MAMC、ALB、PA、TRF指標(biāo)比較(P0.05),差異無統(tǒng)計學(xué)意義;AEI及總熱量達標(biāo)情況比較(P0.05),差異有統(tǒng)計學(xué)意義;住院第3天時兩組患者MUST、AEI、總熱量、ALB和PA比較(P0.05),差異有統(tǒng)計學(xué)意義,AMY、LIP、TRF指標(biāo)比較(P0.05),差異無統(tǒng)計學(xué)意義;出院時兩組AP患者的PREE、AMY、LIP、ALB、PA、TRF、MAC、MAMC比較P0.05,差異無統(tǒng)計學(xué)意義,出院時兩組AP患者的AEI、總熱量達標(biāo)率、TSF和體重減少情況比較P0.05,差異有統(tǒng)計學(xué)意義。結(jié)論AP患者營養(yǎng)不良及營養(yǎng)不良風(fēng)險發(fā)生率極高,個性化的飲食干預(yù)能有效提高AP患者營養(yǎng)支持達標(biāo)率,減少患者體重下降的幅度,緩解了患者因營養(yǎng)不良帶來的免疫功能下降而引起并發(fā)癥的風(fēng)險,有助于患者渡過疾病的危險期;提高了患者的依從性,減少了營養(yǎng)相關(guān)性并發(fā)癥的發(fā)生,也為臨床合理開展?fàn)I養(yǎng)支持提供理論依據(jù)。
[Abstract]:Objective to evaluate the nutritional status of patients with Acute pancreatitis (AP), to explore the effect of individualized dietary intervention on nutritional support of AP patients, and to provide a theoretical basis for the rational development of nutritional support in clinical practice. Methods from October 2015 to October 2016, 62 patients with AP who were hospitalized in the Department of Digestive Medicine (41 and 42) in the first affiliated Hospital of Southern Anhui Medical College were selected as the research objects. AP patients in two wards were randomly checked in according to their beds. The patients in 42 districts were divided into control group (32 cases) and experimental group (30 cases) in 41 ward. The control group was given routine nutritional support treatment and nursing care. On the basis of routine nutritional support therapy and nursing care, the experimental group established individualized diet program to intervene in nursing care according to nutritional risk assessment. (1) General data of AP patients in two groups were collected on admission; (2) patients in two groups were admitted to hospital. On the third day of hospitalization and at discharge, the following data were collected: (1) the nutritional status was assessed with the Universal malnutrition screening tool (MUST); (2) the severity of the disease was assessed with the Bedside Index for severity in Acute sickness scale (BISAP). Degree; (3) using the Changhai pain scale to evaluate the degree of abdominal pain; (4) predicting the predicted energy expenditure value (PREE), the Actual energy intake value (AEI) and the total caloric level; (5) monitoring the blood biochemical indexes. For example, serum amylase (Amy), serum lipase (Lipase lip), serum albumin (Alb), serum prealbumin (PA), serum transferrin (TRFTRF). (3) were measured on admission and discharge weight in two groups of AP patients. Triceps skin fold (TSF), Middle Arm circumference (Arm), and middle Arm cycles circumference (MMC). (4) were used to observe the occurrence of diseases and nutrition-related complications in the whole hospitalization period of the two groups of AP patients. The collected data were analyzed by SPSS 18.0 statistical software. Results the two groups of AP patients in sex, age, marital status, income, education, religious beliefs, causes, abdominal pain degree and BISAP score, P0.05, the difference was not statistically significant, comparable; The score of MUST in the two groups was compared with the TRF index (P0.05). There was no significant difference in AEI and total caloric standard (P0.05). On the third day of hospitalization, there was no significant difference between the two groups in MUST AEI, ALB and PA (P0.05), the difference was statistically significant (P0.05), but there was no significant difference between the two groups at the time of discharge, there was no significant difference between the two groups at the time of discharge, there was no significant difference between the two groups (P 0.05). There were significant differences in AEI, TSF and weight loss between the two groups at discharge (P 0.05). Conclusion the incidence of malnutrition and the risk of malnutrition in AP patients is very high. The individualized dietary intervention can effectively improve the nutritional support rate of AP patients and reduce the rate of weight loss in patients with AP. It alleviates the risk of complications caused by the decrease of immune function caused by malnutrition, helps patients to get through the dangerous period of disease, improves patients' compliance and reduces the occurrence of nutrition-related complications. It also provides a theoretical basis for the rational development of nutritional support in clinical practice.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.5
本文編號：2130386
[Abstract]:Objective to evaluate the nutritional status of patients with Acute pancreatitis (AP), to explore the effect of individualized dietary intervention on nutritional support of AP patients, and to provide a theoretical basis for the rational development of nutritional support in clinical practice. Methods from October 2015 to October 2016, 62 patients with AP who were hospitalized in the Department of Digestive Medicine (41 and 42) in the first affiliated Hospital of Southern Anhui Medical College were selected as the research objects. AP patients in two wards were randomly checked in according to their beds. The patients in 42 districts were divided into control group (32 cases) and experimental group (30 cases) in 41 ward. The control group was given routine nutritional support treatment and nursing care. On the basis of routine nutritional support therapy and nursing care, the experimental group established individualized diet program to intervene in nursing care according to nutritional risk assessment. (1) General data of AP patients in two groups were collected on admission; (2) patients in two groups were admitted to hospital. On the third day of hospitalization and at discharge, the following data were collected: (1) the nutritional status was assessed with the Universal malnutrition screening tool (MUST); (2) the severity of the disease was assessed with the Bedside Index for severity in Acute sickness scale (BISAP). Degree; (3) using the Changhai pain scale to evaluate the degree of abdominal pain; (4) predicting the predicted energy expenditure value (PREE), the Actual energy intake value (AEI) and the total caloric level; (5) monitoring the blood biochemical indexes. For example, serum amylase (Amy), serum lipase (Lipase lip), serum albumin (Alb), serum prealbumin (PA), serum transferrin (TRFTRF). (3) were measured on admission and discharge weight in two groups of AP patients. Triceps skin fold (TSF), Middle Arm circumference (Arm), and middle Arm cycles circumference (MMC). (4) were used to observe the occurrence of diseases and nutrition-related complications in the whole hospitalization period of the two groups of AP patients. The collected data were analyzed by SPSS 18.0 statistical software. Results the two groups of AP patients in sex, age, marital status, income, education, religious beliefs, causes, abdominal pain degree and BISAP score, P0.05, the difference was not statistically significant, comparable; The score of MUST in the two groups was compared with the TRF index (P0.05). There was no significant difference in AEI and total caloric standard (P0.05). On the third day of hospitalization, there was no significant difference between the two groups in MUST AEI, ALB and PA (P0.05), the difference was statistically significant (P0.05), but there was no significant difference between the two groups at the time of discharge, there was no significant difference between the two groups at the time of discharge, there was no significant difference between the two groups (P 0.05). There were significant differences in AEI, TSF and weight loss between the two groups at discharge (P 0.05). Conclusion the incidence of malnutrition and the risk of malnutrition in AP patients is very high. The individualized dietary intervention can effectively improve the nutritional support rate of AP patients and reduce the rate of weight loss in patients with AP. It alleviates the risk of complications caused by the decrease of immune function caused by malnutrition, helps patients to get through the dangerous period of disease, improves patients' compliance and reduces the occurrence of nutrition-related complications. It also provides a theoretical basis for the rational development of nutritional support in clinical practice.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.5
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