本文選題：腦卒中　切入點(diǎn)：腸內(nèi)營(yíng)養(yǎng)　出處：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的分析影響腦卒中患者腸內(nèi)營(yíng)養(yǎng)制劑類型選擇的主要因素,探討不同腸內(nèi)營(yíng)養(yǎng)制劑對(duì)腦卒中患者臨床結(jié)局的影響,為改善腦卒中患者腸內(nèi)營(yíng)養(yǎng)支持治療提供依據(jù)。方法本研究采用回顧性資料分析方法,選擇2015年1月1日~2016年12月31日鄭州市某醫(yī)院腦卒中伴吞咽障礙住院病例(腦梗塞或腦出血),經(jīng)營(yíng)養(yǎng)風(fēng)險(xiǎn)篩查(Nutrition risk screening,NRS 2002),存在營(yíng)養(yǎng)風(fēng)險(xiǎn),并接受鼻胃管管飼的患者病歷共385份。根據(jù)病歷記錄,將患者分為研究組A組(住院期間接受要素膳營(yíng)養(yǎng)支持者)和對(duì)照組B組(住院期間使用自制勻漿膳者)。搜集病歷資料內(nèi)容包括:疾病史、入院時(shí)合并感染情況、入院時(shí)血液檢查結(jié)果、營(yíng)養(yǎng)支持后血液檢查結(jié)果、住院天數(shù)、醫(yī)療花費(fèi)等。應(yīng)用SPSS 21.0的非條件Logistic回歸,對(duì)選擇腸內(nèi)要素膳營(yíng)養(yǎng)治療影響因素進(jìn)行分析,營(yíng)養(yǎng)支持臨床結(jié)局和醫(yī)療花費(fèi)的分析采用t檢驗(yàn)和χ2檢驗(yàn),采用雙側(cè)檢驗(yàn),檢驗(yàn)水準(zhǔn)為α=0.05。結(jié)果1.共搜集385例,研究組(A組)185例,對(duì)照組(B組)200例。入院時(shí)兩組卒中類型、性別、年齡構(gòu)成比、NRS 2002評(píng)分的差異沒(méi)有統(tǒng)計(jì)學(xué)意義(P均0.05),兩組患者具有可比性。2.影響選擇腸內(nèi)要素膳營(yíng)養(yǎng)制劑治療的因素單因素分析結(jié)果顯示:年齡、職業(yè)類型、醫(yī)保類型、合并冠心病、肺部感染、褥瘡、合并感染、谷草轉(zhuǎn)氨酶(Aspartate Transaminase,AST)、血漿白蛋白(Albumin,ALB)、血漿球蛋白(Globulin,GLOB)、血總膽固醇(Total cholesterol,TC)、血高密度脂蛋白膽固醇(High-density lipoprotein cholesterol,HDL-C)、白細(xì)胞(White Blood Cell,WBC)、中性粒細(xì)胞數(shù)、淋巴細(xì)胞數(shù)等因素,A組和B組的差異有統(tǒng)計(jì)學(xué)意義(P均0.05)。非條件Logistic回歸分析結(jié)果顯示:肺部感染(P=0.025,OR=1.91,95%CI=1.084,3.367);中性粒細(xì)胞數(shù)(P0.001,OR=1.19,95%CI=1.106,1.282);HDL-C(P=0.001,OR=0.255,95%CI=0.112,0.579),對(duì)是否選擇要素膳治療有統(tǒng)計(jì)學(xué)意義。3.腦卒中患者接受腸內(nèi)要素膳營(yíng)養(yǎng)支持治療的臨床結(jié)局營(yíng)養(yǎng)治療后血漿總蛋白(Total Protein,TP)、ALB、GLOB明顯提高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);營(yíng)養(yǎng)治療后WBC及中性粒細(xì)胞數(shù)明顯下降,血紅蛋白(Hemoglobin,Hb)和紅細(xì)胞比容(Red Blood Cell Specific Volume,HCT)降低(P均0.05)。營(yíng)養(yǎng)支持治療后血尿酸(Uric acid,UA)、總膽紅素(Total Bilirubin,TBIL)明顯降低(P均0.05)。4.患者平均住院時(shí)間A組為(24.04±14.47)天,B組為(27.45±16.44)天,差異有統(tǒng)計(jì)學(xué)意義(P=0.032)。平均醫(yī)療花費(fèi)A組為(77273.78±5681.89)元,B組為(58425.91±4131.96)元,差異有統(tǒng)計(jì)學(xué)意義(P=0.007)。結(jié)論1.促進(jìn)選擇腸內(nèi)要素膳治療的影響因素包括:肺部感染、中性粒細(xì)胞數(shù)。2.腸內(nèi)要素膳治療患者平均住院時(shí)間短于自制勻漿膳組,但平均醫(yī)療花費(fèi)高于自制勻漿膳組。3.腸內(nèi)要素膳營(yíng)養(yǎng)治療可獲得明確的臨床療效。
[Abstract]:Objective to analyze the main factors influencing the selection of enteral nutrition preparations in stroke patients, and to explore the effects of different enteral nutrition preparations on the clinical outcome of stroke patients, so as to provide evidence for improving enteral nutrition support therapy in stroke patients.Methods A retrospective data analysis method was used to study the nutritional risk of stroke patients with dysphagia (cerebral infarction or cerebral hemorrhage) in a hospital of Zhengzhou from 1 January 2015 to 31 December 2016.A total of 385 patients received nasogastric tube feeding.According to the medical records, the patients were divided into two groups: group A (group A received essential meal nutrition during hospitalization) and group B (group B with self-made homogenate diet during hospitalization).The contents of medical records included: history of disease, complicated infection on admission, blood examination results on admission, blood examination results after nutrition support, hospitalization days, medical expenses and so on.Using the non-conditional Logistic regression of SPSS 21.0, the factors influencing the nutritional treatment of selected enteral element meal were analyzed. T test and 蠂 2 test were used to analyze the clinical outcome and medical cost of nutrition support, and bilateral test was used, the test level was 偽 -0. 05.Result 1.385 cases were collected, 185 cases in group A in study group and 200 cases in group B in control group.There was no significant difference in stroke type, sex, age ratio and NRS 2002 score between the two groups at admission (P < 0.05).The results of univariate analysis showed that age, occupational type, type of medical insurance, coronary heart disease, pulmonary infection, bedsore, infection, etc.After nutritional therapy, the total protein of plasma total protein WBC and neutrophilic granulocyte were significantly increased (P 0.05), and the number of WBC and neutrophils were significantly decreased after nutritional therapy in patients with stroke, and there was a significant difference between the two groups in the number of WBC and neutrophilic granulocytes.Hemoglobin hemoglobin (HB) and red Blood Cell Specific volume (HCT) decreased by 0.05.Total bilirubin TBILs decreased significantly after nutritional support treatment.The average hospitalization time of patients in group A was 24.04 鹵14.47 days and that in group B was 27.45 鹵16.44 days. The difference was statistically significant.The average medical cost of group A was 77273.78 鹵5681.89 yuan and that of group B was 58425.91 鹵4131.96 yuan. The difference was statistically significant.Conclusion 1.Factors that contribute to the selection of enteric diet include pulmonary infection, neutrophil count, and neutrophils.The average hospitalization time of the patients treated with enteral element diet was shorter than that of the homogenate diet group, but the average medical cost was higher than that of the homogenate diet group.The nutritional therapy of enteral element diet can obtain definite clinical curative effect.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3;R459.3
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本文編號(hào)：1718398