急性胰腺炎患者营养筛查及个性化饮食干预效果研究

发布时间：2018-07-17 17:21

【摘要】：目的评价急性胰腺炎(Acute Pancreatitis,AP)患者营养状况,探讨个性化饮食干预对AP患者营养支持效果,为临床合理开展营养支持提供理论依据。方法选取2015年10月至2016年10月在皖南医学院第一附属医院消化内科(41病区和42病区)住院经临床确诊的62例AP患者为研究对象。两个病区AP患者是根据床位随机入住,将在42病区住院患者设为对照组(32例),在41病区住院患者设为实验组(30例);对照组给予常规的营养支持治疗和护理,实验组在常规营养支持治疗护理基础上,根据营养风险评估情况,制定个性化饮食方案进行护理干预。(1)入院时收集两组AP患者的一般资料;(2)两组患者分别在入院时、住院第3天和出院时进行如下资料收集(1)采用通用型营养不良筛查工具(Malnutrition Universal Screening Tool,MUST)进行营养状况评估;(2)采用疾病严重程度(Bedside Index for Severity in Acute Pancreatitis,BISAP)评分表评估患者疾病严重程度;(3)采用长海痛尺评价其腹痛程度;(4)预测两组患者能量消耗值(Predictable Resting Energy Expenditure,PREE)、实际能量摄入值(Actual Energy Intake,AEI)及总热量达标情况;(5)监测血生化指标,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)、血清转铁蛋白(transferrin,TRF)。(3)测量两组AP患者入院时和出院时体重、三头肌皮褶厚度(Triceps Skin Fold,TSF)、上臂围(Middle Arm Circumference,MAC)、上臂肌围(Middle Arm Muscles Circumference,MAMC)。(4)观察两组AP患者在整个住院期间疾病及营养相关并发症发生情况。收集的资料采用SPSS18.0统计软件对数据进行统计分析。结果两组AP患者在性别、年龄、婚姻状况、收入、文化程度、宗教信仰、致病原因、腹痛程度、BISAP评分等一般资料方面P0.05,差异无统计学意义,具有可比性;两组AP患者入院时MUST得分、PREE、AMY、LIP、TSF、MAC、MAMC、ALB、PA、TRF指标比较(P0.05),差异无统计学意义;AEI及总热量达标情况比较(P0.05),差异有统计学意义;住院第3天时两组患者MUST、AEI、总热量、ALB和PA比较(P0.05),差异有统计学意义,AMY、LIP、TRF指标比较(P0.05),差异无统计学意义;出院时两组AP患者的PREE、AMY、LIP、ALB、PA、TRF、MAC、MAMC比较P0.05,差异无统计学意义,出院时两组AP患者的AEI、总热量达标率、TSF和体重减少情况比较P0.05,差异有统计学意义。结论AP患者营养不良及营养不良风险发生率极高,个性化的饮食干预能有效提高AP患者营养支持达标率,减少患者体重下降的幅度,缓解了患者因营养不良带来的免疫功能下降而引起并发症的风险,有助于患者渡过疾病的危险期;提高了患者的依从性,减少了营养相关性并发症的发生,也为临床合理开展营养支持提供理论依据。
[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.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

【参考文献】