老年神经重症患者肠内营养不耐受预防和管理最佳证据的应用研究

Application of the best evidence for prevention and management of enteral nutrition intolerance in elderly patients with severe neurological disease

中文关键词: 老年, 神经系统疾病, 肠内营养, 喂养不耐受, 最佳证据

英文关键词: elderly  neurological disease  enteral nutrition  feeding intolerance  best evidence

中文摘要:

      目的 通过文献检索和循证等方法对搜集的证据进行评估与总结,形成最佳证据,希望能够为临床老年神经重症患者肠内喂养提供参考依据.方法 前瞻性选取2022年1月-2023年12月在海南省人民医院接受治疗的140例老年神经重症患者作为研究对象,依据随机数字表法分为观察组和对照组,每组70例.对照组患者行常规肠内营养干预,观察组在对照组相同干预的基础上加用基于肠内营养不耐受预防和管理最佳证据干预.记录并比较2组干预前后营养指标值、免疫功能指标值及喂养不耐受和误吸发生率.结果 干预后,2组患者血红蛋白、总蛋白、前白蛋白、白蛋白及IgM、IgG、IgA水平均高于同组干预前(P＜0.05),且观察组上述检测指标水平均高于对照组(P＜0.05).观察组患者肠内营养不耐受、误吸发生率均低于对照组(P＜0.05).结论 基于肠内营养不耐受预防和管理最佳证据干预模式可改善老年神经重症患者的营养状态和免疫功能,降低患者肠内营养不耐受发生率.

英文摘要:

      Objective To evaluate and summary the collected evidences to form the best evidence by means of literature search and evidence-based methods,and provide reference for enteral feeding in clinical elderly patients with severe neurologi-cal disease.Methods 140 elderly patients with severe neurological disease who received treatment in People's Hospital of Hainan Province from January 2022 to December 2023 were prospectively selected as research subjects,and divided into obser-vation group and control group according to random number table method,with 70 cases in each group.The control group re-ceived routine enteral nutrition intervention,and the observation group received intervention based on the best evidence for the prevention and management of enteral nutrition intolerance on the basis of the same intervention in the control group.The nutri-tional indexes,immune function indexes,feeding intolerance and incidence of aspiration were recorded and compared between the two groups before and after intervention.Results After intervention,the levels of hemoglobin,total protein,prealbumin,albumin,IgM,IgG and IgA in both groups were higher than those in the same group before intervention,and the observation group was higher than the control group(P＜0.05).The incidence of enteral nutritional intolerance and aspiration in the obser-vation group were lower than those in the control group(P＜0.05).Conclusion The intervention model based on the best ev-idence for the prevention and management of enteral nutritional intolerance can improve the nutritional status and immune func-tion of elderly patients with severe neurological disease,and reduce the incidence of enteral nutritional intolerance.