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护理学报 ›› 2021, Vol. 28 ›› Issue (7): 1-5.doi: 10.16460/j.issn1008-9969.2021.07.001

• 研究生园地 •    下一篇

基于昼夜节律机制对ICU老年患者肠内营养延续性护理的对照研究

杜金磊1, 陈志美1, 秦兰芳1, 廉洁1, 孙文静1, 王翔2, 徐巍2, 邹晓月2   

  1. 1.湖州师范学院,浙江 湖州 313000;
    2.湖州市第一人民医院,浙江 湖州 313000
  • 收稿日期:2020-11-02 出版日期:2021-04-10 发布日期:2021-05-12
  • 通讯作者: 邹晓月（1976-）,女,浙江湖州人,本科学历,主任护师,硕士研究生导师。E-mail：1831660976@qq.com
  • 作者简介:杜金磊（1994-）,男,四川南充人,本科学历,硕士研究生在读,护师。
  • 基金资助:
    浙江省医药卫生科技计划项目（2020RC119）; 国家自然科学基金面上项目（81970570）

Development and Application of Extended Enteral Nutrition Management Scheme for Elderly ICU Patients Based on Circadian Rhythm

DU Jin-lei1, CHEN Zhi-mei1, QIN Lan-fang1, LIAN Jie1, SUN Wen-jing1, WANG Xiang2, XU Wei2, ZOU Xiao-yue2   

  1. 1. Huzhou University, Huzhou 313000, China;
    2. Huzhou First People’s Hospital, Huzhou 313000, China
  • Received:2020-11-02 Online:2021-04-10 Published:2021-05-12

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摘要： 目的 以昼夜节律机制为理论基础为ICU老年患者探索一套肠内营养延续性护理方案,从而降低该类患者经口进食早期消化道事件的发生风险。方法 随机抽取我院58例行肠内营养治疗的老年患者展开非同期随机对照研究,在肠内营养治疗结束前对照组患者采用常规护理措施,观察组患者采用延续性护理方案,比较2组患者经口进食早期腹胀评分、肠鸣音听诊、促胃动力药物应用事件、夜间饥饿事件以及患者满意度评分是否存在差异性。结果 2组患者经口进食早期在腹胀评分、肠鸣音听诊、累计用药频数、夜间饥饿事件累计频数以及操作护理评分差异存在统计学意义（P<0.05）,在每日促胃动力药物使用频数以及夜间饥饿事件发生频数差异无统计学意义（P>0.05）。结论 肠内营养延续性护理方案对于ICU老年患者饮食过渡具有良好的适用性。

关键词: 昼夜节律, 肠内营养, 延续性护理

Abstract: Objective To develop an extended management scheme of enteral nutrition (EN) for elderly ICU patients based on circadian rhythm, and to reduce the occurrence of early gastrointestinal adverse events by oral feeding. Methods Non-randomized concurrent controlled trial (Non-R) was conducted in 58 randomly-selected elderly patients receiving enteral nutrition therapy. Patients in the control group were treated by routine nursing before the end of enteral nutrition therapy, while those in the observation group by extended management scheme of EN. Abdominal distention, bowel sounds, application of medications for promoting gastric motility, hunger at night as well as patient satisfaction in the two groups were compared. Results There was statistical significance in terms of abdominal distention, bowel sounds, accumulative frequency of drug use, cumulative frequency of hunger at night and nursing scoring in the two groups (P<0.05). But daily frequency of drug use for promoting gastric motility and daily frequency of hunger at night showed no statistical difference (P>0.05). Conclusion The extended management scheme of EN for elderly ICU patients has good applicability for diet transition of elderly patients in ICU.

Key words: circadian rhythm, enteral nutrition, extended management

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  • R473
[1] Smolensky MH, Hermida RC, Reinberg A, et al.Circadian Disruption: New Clinical Perspective of Disease Pathology and Basis for Chronotherapeutic Intervention[J]. Chronobiol Int, 2016, 33(8):1101-1119.DOI:10.1080/07420528.2016.1184678.
[2] Gombert M, Carrasco-Luna J, Pin-Arboledas G, et al.The Connection of Circadian Rhythm to Inflammatory Bowel Disease[J]. Transl Res, 2019,206(4):107-118.DOI:10.1016/j.trsl.2018.12.001.
[3] Codoner-Franch P, Gombert M.Circadian Rhythms in the Pathogenesis of Gastrointestinal Diseases[J]. World J Gastroenterol, 2018,24(38):4297-4303.DOI:10.3748/wjg.v24.i38.4297.
[4] 黑利娟,马士芬,徐俊荣. 昼夜节律与胃肠道动力及肠道菌群的关系[J]. 国际消化病杂志, 2018,38(4):230-232.DOI:10.3969/j.issn.
[5] Sunderram J, Sofou S, Kamisoglu K, et al.Time-Restricted Feeding and the Realignment of Biological Rhythms: Translational Opportunities and Challenges[J].J Transl Med, 2014,12(28):79.DOI:10.1186/1479-5876-12-79.
[6] Krom H, de Winter JP, Kindermann A. Development, Prevention, and Treatment of Feeding Tube Dependency[J]. Eur J Pediatr, 2017,176(6):683-688.DOI:10.1007/s00431-017-2908-x.
[7] Manoogian E, Panda S. Circadian Rhythms, Time-restricted Feeding, and Healthy Aging[J]. Ageing Research Reviews, 2017,39(10):59-67.DOI:10.1016/j.arr.2016.12.006.
[8] 中华医学会肠外肠内营养学分会老年营养支持学组. 中国老年患者肠外肠内营养应用指南(2020)[J]. 中华老年医学杂志, 2020,39(2):119-122.DOI:10.3760/cma.j.issn.0254-9026.2020.02.002.
[9] Menculini G, Brufani F, Del BV, et al.Circadian Rhythms Disruptions and Eating Disorders: Clinical Impact and Possible Psychopathological Correlates[J]. Psychiatr Danub, 2019,31(3):497-502.
[10] Kaczmarek JL, Thompson SV, Holscher HD.Complex Interactions of Circadian Rhythms, Eating Behaviors, and the Gastrointestinal Microbiota and Their Potential Impact On Health[J]. Nutr Rev, 2017, 75(9):673-682.DOI:10.1093/nutrit/nux036.
[11] 陈霞. 肝胆胰外科术后患者疲劳综合征应用中医护理临床观察[J]. 新中医, 2015,47(5):291-292.DOI:10.13457/j.cnki.jncm.2015.05.136.
[12] 胡月,李倩,谭琳,等. 基于德尔菲法对护理硕士专业学位研究生临床思维能力评价指标体系的构建[J].护理学报, 2018,25(7):1-5.DOI:10.16460/j.issn1008-9969.2018.07.001.
[13] 郭雅博. 肝癌患者术后腹胀症状集束化护理方案的构建及效果评价[D]. 新乡:新乡医学院, 2019.
[14] 蒋茹. 诊断学[M]. 北京:科学出版社, 2017:192-193.
[15] 叶玉芬,李杏崧,伍存娣. 护理关怀理念改善ICU危重患者护理质量及满意度的效果[J]. 中国医药科学, 2020,10(2):149-151.DOI:10.3969/j.issn.2095-0616.2020.02.044.
[16] Wilken M, Bartmann P, Dovey TM, et al.Characteristics of Feeding Tube Dependency with Respect to Food Aversive Behaviour and Growth[J]. Appetite, 2018,123(2):1-6.DOI:10.1016/j.appet.2017.11.107.
[17] Billings ME,Watson NF.Circadian Dysrhythmias in the Intensive Care Unit[J]. Crit Care Clin, 2015,31(3):393-402.DOI:10.1016/j.ccc.2015.03.006.
[18] Sulli G, Manoogian E, Taub PR, et al.Training the Circadian Clock, Clocking the Drugs, and Drugging the Clock to Prevent, Manage, and Treat Chronic Diseases[J]. Trends Pharmacol Sci,2018, 39(9):812-827.DOI:10.1016/j.tips.2018.07.003.
[19] Martinez-Bakker M, Helm B.The Influence of Biological Rhythms on Host-parasite Interactions[J]. Trends Ecol Evol, 2015,30(6):314-326.DOI:10.1016/j.tree.2015.03.012.
[20] McKenna HT, Reiss IK, Martin DS. The Significance of Circadian Rhythms and Dysrhythmias in Critical Illness[J]. J Intensive Care Soc, 2017,18(2):121-129.DOI:10.1177/1751143717692603.
[21] Schibler U, Gotic I, Saini C, et al.Clock-Talk: Interactions between Central and Peripheral Circadian Oscillators in Mammals[J]. Cold Spring Harb Symp Quant Biol, 2015,80(10):223-232.DOI:10.1101/sqb.2015.80.027490.
[22] Zerón-Rugerio MF, Díez-Noguera A, Izquierdo-Pulido M, et al.Higher Eating Frequency is Associated with Lower Adiposity and Robust Circadian Rhythms:a Cross-sectional Study[J]. Am J Clin Nutr, 2020,23(10):282.DOI:10.1093/ajcn/nqaa282.
[23] Codoñer-Franch P, Gombert M.Circadian Rhythms in the Pathogenesis of Gastrointestinal Diseases[J]. World J Gastroenterol,2018,24(38):4297-4303.DOI:10.3748/wjg.v24.i38.4297.
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