夜间加餐对住院慢加急性肝功能衰竭患者营养状况的干预研究

发布时间：2018-05-14 07:23

本文选题：夜间加餐 + 慢加急性肝功能衰竭　；参考：《郑州大学》2017年硕士论文

【摘要】：研究目的(1)在了解慢加急性肝功能衰竭患者的营养风险的基础上给予夜间加餐,观察对患者营养状态、肝功能恢复、营养风险、并发症发生率的影响,以期减少患者并发症,提高生活质量,改善临床结局和预后;(2)为慢加急肝功能衰竭患者寻找一种价格低廉并有效的加餐模式;(3)为临床实践中实施有效的护理措施、促进慢加急肝功能衰竭患者的康复提供理论依据。研究方法本研究选取2015年12月到2016年6月进入郑州市某三级综合医院感染科就诊的101例慢加急性肝功能衰竭患者,分为夜间加餐研究组和对照组。用抛硬币法随机将感染一病区患者分为对照组,接受一般内科综合治疗+日间营养干预;感染二病区患者为研究组,在一般内科综合治疗+日间营养干预的基础上加夜间加餐,加餐内容:小面包40g+酸奶100ml。加餐时间为睡前半小时或晚9-10点加餐,观察周期为入院24小时后至住院一个月。两组均在入院48小时内,入院一周后,入院一月后记录营养相关指标。包括一般情况调查表、NRS-2002评分、实验室指标:肝功能(白蛋白、前白蛋白);特种蛋白(转铁蛋白)、人体测量学指标:体重、体重指数(BMI)、上臂肌围(MAMC)、肱三头肌皮褶厚度(TSF)、入院和出院时患者Child-Pugh评分、两组患者并发症、住院时间、住院期间输注白蛋白量以及患者疾病转归情况。本研究所有数据资料进行统计学分析均使用SPSS 21.0,其中检验水准定为α=0.05。统计分析结果均用x±s表示。主要运用包括独立样本t检验、重复测量的方差分析、χ2检验及稚和检验等统计学方法来完成数据的统计分析。结果1.本研究入组病例共120例,其中干预组及对照组均为60例,研究过程中,因肝移植手术、病情加重、死亡等原因脱落19例,样本流失率为15.8%。共有101例患者完成整个干预过程,干预组50例,对照组51例。干预前两组患者干预前一般情况资料处于均衡状态,统计学分析显示两组差异无统计学意义(P0.05);2.两组患者干预前后营养风险NRS-2002评分的比较:干预组患者干预前的NRS-2002评分为(1.60±0.81)分,对照组评分为(1.75±0.74)分,统计学分析显示两组间差异没有统计学意义(P0.05)。干预一个月后,干预组的NRS-2002评分较对照组低,两组相比差异有统计学意义(P0.05)。3.干预前后两组患者Child-Pugh评分的比较:干预前干预组患者ChildPugh评分为(9.54±0.76)分,对照组为(9.73±1.02)分,统计学分析显示两组间差异没有统计学意义(P0.05)。干预一个月后,干预组的Child-Pugh评分较对照组低,两组相比差异有统计学意义(P0.05);4.干预前后两组患者营养相关的身体测量指标的比较:两组患者的皮褶厚度值在干预前,干预一周、干预一个月相比均没有统计学差异(P0.05);两组患者的上臂围值在干预前,干预一周、相比均没有统计学差异(P0.05),干预一个月后,两组相比差异有统计学意义(P0.05);两组患者的体重值在干预前,干预一周、相比均没有统计学差异(P0.05),随着时间的延长,在干预一个月后干预组的体重值要明显高于对照组,有统计学差异(P0.05);BMI值在干预前,干预一周、干预一个月相比差异无统计学意义(P0.05)。5.两组患者干预前后营养相关的生化指标的比较:两组患者的血清白蛋白值在干预前,干预一周后相比均没有统计学差异(P0.05),随着时间的延长,在干预一个月后干预组的血清白蛋白值要明显高于对照组,有统计学差异(P0.05);两组患者的前白蛋白值在干预前,干预一周后相比没有统计学差异(P0.05),干预一个月后两组前白蛋白值有统计学差异(P0.05);两组患者的转铁蛋白值在干预前,干预一周后相比均没有统计学差异(P0.05),干预一个月后两组转铁蛋白值有统计学差异(P0.05)。6.两组患者住院期间临床结局指标的比较:干预后发现:住院期间两组患者的并发症发生率有统计学差异(P0.05);感染性相关并发症的差异没有统计学意义(P0.05);非感染性相关并发症的发生率有统计学差异(P0.05)。干预后对两组患者住院期间输注白蛋白量和住院时间进行组间比较,两组患者住院期间输注白蛋白的量没有统计学意义(P0.05),两组患者住院时间有统计学差异(P0.05);干预后对两组患者的临床结局进行两两比较,两组患者临床转归,差异没有统计学意义(P0.05)。结论1.本研究证明营养风险在慢加急性肝功能衰竭患者中广泛存在,需要在临床工作中引起关注并及时给予治疗;2.在常规治疗护理的基础上,夜间加餐可以有效降低慢加急性肝功能衰竭患者的NRS-2002评分、Child-Pugh评分;3.夜间加餐在短期内改善患者BMI、皮褶厚度等方面效果不明显,但在干预一月后改善血清白蛋白、前白蛋白、转铁蛋白等方面效果明显;4.夜间加餐对于住院期间两组患者的并发症发生率有影响,尤其体现在非感染性相关并发症方面;夜间加餐对两组患者住院期间输注白蛋白的量没有影响;住院期间短期的夜间加餐对患者临床转归并不能带来明显积极的影响。
[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.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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