摘要
目的探究基于“破窗效应”的干预模式在神经重症监护病房(NICU)脑出血患者营养支持中的应用效果。方法选取2023年4月至2024年2月郑州大学第一附属医院NICU收治的164例脑出血患者作为研究对象,按随机数表法分为观察组和对照组各82例。对照组患者在营养支持期间予以常规干预,观察组患者在上述基础上予以基于“破窗效应”的干预模式,两组患者均连续干预10 d。比较两组患者的康复情况、干预前后机体电解质水平、营养状态[白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF)]、功能状态[神经功能(NIHSS)、认知功能(MMSE)、日常生活能力(ADL)]及再喂养综合征(RFS)发生率。结果观察组患者的尿管留置、NICU入住及住院时间分别为(6.36±2.28)d、(9.32±1.85)d、(23.85±4.78)d,明显短于对照组的(8.63±6.67)d、(11.47±2.23)d、(28.96±6.10)d,差异均有统计学意义(P<0.05);干预后,观察组患者的钾、磷、镁水平分别为(3.82±0.42)mmoL/L、(0.88±0.16)mmoL/L、(0.76±0.21)mmoL/L,明显高于对照组的(3.46±0.51)mmoL/L、(0.70±0.15)mmoL/L、(0.70±0.17)mmoL/L,差异均有统计学意义(P<0.05);干预后,观察组患者的ALB、PA、TRF水平分别为(39.98±3.67)g/L、(0.32±0.07)g/L、(3.14±0.73)g/L,明显高于对照组的(36.01±2.96)g/L、(0.26±0.05)g/L、(2.65±0.51)g/L,差异均有统计学意义(P<0.05);干预后,观察组患者的NIHSS评分(9.52±2.45)分,明显低于对照组的(12.16±2.37)分,MMSE、ADL评分分别为(14.26±3.02)分、(41.56±4.10)分,明显高于对照组的(10.31±2.95)分、(39.57±6.75)分,差异均有统计学意义(P<0.05);观察组患者的RFS发生率为4.88%,明显低于对照组的21.95%,差异有统计学意义(P<0.05)。结论基于“破窗效应”的干预模式可降低ICU脑出血患者RFS风险,加速康复进程,并在改善患者营养状态、纠正电解质水平、促进神经功能恢复方面具有明显作用,可在临床推广应用。
Objective To explore the application effect of intervention mode based on the broken window effect in the nutritional support of patients with cerebral hemorrhage in the Neuro-Intensive Care Unit(NICU).Methods A total of 164 patients with cerebral hemorrhage admitted to the NICU of the First Affiliated Hospital of Zhengzhou University from April 2023 to February 2024 were selected as the research objects.According to the random number table method,they were randomly divided into an observation group and a control group,with 82 patients in each group.The patients in the control group received routine intervention during the nutritional support period,while the patients in the observa-tion group received an intervention model based on the broken window effect on the basis of the treatment in the control group.Both groups of patients were continuously intervened for 10 days.The rehabilitation status and incidence of refeeding syn-drome(RFS),as well as the body electrolyte levels,nutritional status(albumin,ALB;prealbumin,PA;transferrin,TRF),and functional status(neurological function,NIHSS;cognitive function,MMSE;activities of daily living,ADL)before and after in-tervention were compared between the two groups.Results The indwelling catheter,length of NICU stay,and length of hospital stay in the observation group were(6.36±2.28)d,(9.32±1.85)d,and(23.85±4.78)d,respectively,which were sig-nificantly shorter than(8.63±6.67)d,(11.47±2.23)d,and(28.96±6.10)d in the control group(P<0.05).After intervention,the potassium,phosphorus,and magnesium levels in the observation group were(3.82±0.42)mmol/L,(0.88±0.16)mmol/L,and(0.76±0.21)mmol/L,respectively,which were significantly higher than(3.46±0.51)mmol/L,(0.70±0.15)mmol/L,and(0.70±0.17)mmol/L in the control group(P<0.05).After intervention,the levels of ALB,PA,and TRF in the obser-vation group were(39.98±3.67)g/L,(0.32±0.07)g/L,and(3.14±0.73)g/L,respectively,which were significantly higher than(36.01±2.96)g/L,(0.26±0.05)g/L,and(2.65±0.51)g/L in the control group(P<0.05).After intervention,the NIHSS score of the observation group was(9.52±2.45)points,which was significantly lower than(12.16±2.37)points of the control group.After intervention,the NIHSS score of the observation group was(9.52±2.45)points,which was significantly lower than(12.16±2.37)points in the control group,while the MMSE and ADL scores were(14.26±3.02)points and(41.56±4.10)points,respectively,significantly higher than(10.31±2.95)points and(39.57±6.75)points in the control group(P<0.05).The incidence of RFS in the observation group was 4.88%,which was significantly lower than 21.95%in the control group(P<0.05).Conclusion The intervention model based on broken window effect can reduce the risk of RFS in ICU patients with cerebral hemorrhage,accelerate the rehabilitation process,and have a significant ef-fect in improving the nutritional status of patients,correcting electrolyte levels,and promoting the recovery of neurologi-cal function.It can be widely applied in clinical practice.
作者
孙冬丽
任行龙
马丽霞
翟会民
SUN Dong-li;REN Xing-long;MA Li-xia;ZHAI Hui-min(Neurological Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,CHINA)
出处
《海南医学》
CAS
2024年第17期2548-2552,共5页
Hainan Medical Journal
基金
河南省医学科技攻关计划省部共建重点项目(编号:SBGJ202102082)。
关键词
脑出血
基于“破窗效应”的干预模式
再喂养综合征
防控
营养支持
Cerebral hemorrhage
Intervention model based on broken window effect
Refeeding syndrome
Prevention and control
Nutritional support
