医护一体化营养管理模式在全喉切除术后的应用

doi:10.6040/j.issn.1673-3770.1.2018.047

摘要/Abstract

摘要： 目的

探讨医护一体化营养管理模式在全喉切除术后的应用效果，观察患者的恢复情况，提升护理工作能力。

方法

将2017年4月至2018年9月共68例行全喉切除术喉癌患者，随机分为医护一体化营养管理干预组及对照组，每组34例，医护一体化营养管理干预组由医生与护士共同参与，每日由护士根据患者的身高、体质量、基础代谢率，计算患者的每日目标营养量，根据目标营养量采用肠内营养泵经鼻胃管每日给予肠内营养制剂，并且全程营养管理干预，进行质量控制；对照组给予常规模式营养干预，采用注射器经鼻胃管给予普通流质。观察患者术后1周血清前蛋白、白蛋白及BMI的变化，对术后住院时间和生活自理能力的影响，以及并发症和不良反应的发生情况。

结果

医护一体化营养管理干预组患者术后1周血清前蛋白、白蛋白及BMI均高于对照组，差异均有统计学意义（P<0.05）。医护一体化营养管理干预组患者术后的生活自理能力提高明显，术后住院时间缩短，且并发症和不良反应的发生率明显降低，与对照组相比，差异均有统计学意义（P<0.05）。

结论

全喉切除术后采用医护一体化营养管理干预可显著改善患者的营养状况，提高生活自理能力，缩短住院时间，减少并发症和不良反应的发生。

关键词: 喉切除术, 医护一体化, 营养支持, 护理估计

Abstract: Objective

To explore the effects of the application of the integration of doctors′ and nurses′ nutrition management model after total laryngectomy, observe the recovery of patients, and improve nursing services.

Methods

From April 2017 to September 2018, 68 patients with laryngeal cancer undergoing total laryngectomy were randomly divided into nutrition management intervention and control groups. Each group included 34 patients. The nutrition management intervention group was attended by doctors and nurses. Nurses calculated the daily target nutrition according to the patients′ height, weight, and basal metabolic rate. According to the target nutrition, enteral nutrition preparation was administered daily through a nasogastric tube by an enteral nutrition pump, and nutrition management intervention was carried out throughout the course of quality control. The control group was offered routine nutritional intervention, and a syringe was used to administer normal fluids through a nasogastric tube. Changes in serum prealbumin, albumin, and body mass index (BMI) were observed one week after the surgery. Postoperative hospital stay, self-care ability, complications, and the incidence of adverse reactions were evaluated.

Results

The level of serum prealbumin, level of albumin, and BMI in the integration of doctors′ and nurses′ nutrition management intervention group were higher than those in the control group one week after the surgery, and the difference was statistically significant (P<0.05). Patients in the nutrition management intervention group had better self-care ability, shorter hospital stays, and a lower incidence of complications and adverse reactions compared with those in the control group, and the difference was statistically significant (P<0.05).

Conclusion

Application of the integration of doctors′ and nurses′ nutrition management intervention after total laryngectomy can significantly improve the nutritional status of patients, improve self-care ability, shorten hospital stay, and through careful nursing observation and treatment, can reduce complications and adverse reactions.

Key words: Laryngectomy, Integration of doctors and nurses, Nutritional support, Nursing assessment

中图分类号:

R473.76

高俊芳,刘萍. 医护一体化营养管理模式在全喉切除术后的应用[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 143-146.

Junfang GAO,Ping LIU. Application of the integration of doctors′ and nurses′ nutrition management model after total laryngectomy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 143-146.

图/表 2

表1

两组患者术前一般情况比较"

指标	对照组	医护一体化营养管理干预组	t /χ²	P
男/女（n）	31/3	33/1	0.52	0.302
年龄（ $x ˉ ± s$ ，岁）	64±15	63±18	0.25	0.804
BMI（ $x ˉ ± s$ ）	21.8±2.7	20.9±2.2	1.51	0.137
血清前蛋白（ $x ˉ ± s$ ，g/L)	0.20±0.07	0.21±0.05	0.68	0.500
血清白蛋白（ $x ˉ ± s$ ，g/L)	37.1±3.8	36.7±4.7	0.39	0.701

表1

表2

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指标	对照组	医护一体化营养管理干预组	t	P
血清前蛋白（g/L）	0.19±0.04	0.22±0.05	2.73	0.008
血清白蛋白（g/L）	32.60±2.70	34.4±2.8	2.70	0.009
BMI	18.60±1.60	20.3±2.4	3.44	0.001

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