脑卒中患者肠内营养制剂应用的影响因素及其临床结局的分析

发布时间：2018-04-06 06:30

  本文选题：脑卒中　切入点：肠内营养　出处：《郑州大学》2017年硕士论文

【摘要】：目的分析影响脑卒中患者肠内营养制剂类型选择的主要因素,探讨不同肠内营养制剂对脑卒中患者临床结局的影响,为改善脑卒中患者肠内营养支持治疗提供依据。方法本研究采用回顾性资料分析方法,选择2015年1月1日~2016年12月31日郑州市某医院脑卒中伴吞咽障碍住院病例(脑梗塞或脑出血),经营养风险筛查(Nutrition risk screening,NRS 2002),存在营养风险,并接受鼻胃管管饲的患者病历共385份。根据病历记录,将患者分为研究组A组(住院期间接受要素膳营养支持者)和对照组B组(住院期间使用自制匀浆膳者)。搜集病历资料内容包括:疾病史、入院时合并感染情况、入院时血液检查结果、营养支持后血液检查结果、住院天数、医疗花费等。应用SPSS 21.0的非条件Logistic回归,对选择肠内要素膳营养治疗影响因素进行分析,营养支持临床结局和医疗花费的分析采用t检验和χ2检验,采用双侧检验,检验水准为α=0.05。结果1.共搜集385例,研究组(A组)185例,对照组(B组)200例。入院时两组卒中类型、性别、年龄构成比、NRS 2002评分的差异没有统计学意义(P均0.05),两组患者具有可比性。2.影响选择肠内要素膳营养制剂治疗的因素单因素分析结果显示:年龄、职业类型、医保类型、合并冠心病、肺部感染、褥疮、合并感染、谷草转氨酶(Aspartate Transaminase,AST)、血浆白蛋白(Albumin,ALB)、血浆球蛋白(Globulin,GLOB)、血总胆固醇(Total cholesterol,TC)、血高密度脂蛋白胆固醇(High-density lipoprotein cholesterol,HDL-C)、白细胞(White Blood Cell,WBC)、中性粒细胞数、淋巴细胞数等因素,A组和B组的差异有统计学意义(P均0.05)。非条件Logistic回归分析结果显示:肺部感染(P=0.025,OR=1.91,95%CI=1.084,3.367);中性粒细胞数(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),对是否选择要素膳治疗有统计学意义。3.脑卒中患者接受肠内要素膳营养支持治疗的临床结局营养治疗后血浆总蛋白(Total Protein,TP)、ALB、GLOB明显提高,差异有统计学意义(P0.05);营养治疗后WBC及中性粒细胞数明显下降,血红蛋白(Hemoglobin,Hb)和红细胞比容(Red Blood Cell Specific Volume,HCT)降低(P均0.05)。营养支持治疗后血尿酸(Uric acid,UA)、总胆红素(Total Bilirubin,TBIL)明显降低(P均0.05)。4.患者平均住院时间A组为(24.04±14.47)天,B组为(27.45±16.44)天,差异有统计学意义(P=0.032)。平均医疗花费A组为(77273.78±5681.89)元,B组为(58425.91±4131.96)元,差异有统计学意义(P=0.007)。结论1.促进选择肠内要素膳治疗的影响因素包括:肺部感染、中性粒细胞数。2.肠内要素膳治疗患者平均住院时间短于自制匀浆膳组,但平均医疗花费高于自制匀浆膳组。3.肠内要素膳营养治疗可获得明确的临床疗效。
[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 伪 -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 卤14.47 days and that in group B was 27.45 卤16.44 days. The difference was statistically significant.The average medical cost of group A was 77273.78 卤5681.89 yuan and that of group B was 58425.91 卤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.
【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】：R743.3;R459.3
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本文编号：1718398