| 杨瑞霞,曹培超,田卫平.基于循证理念的集束化护理干预对颅脑损伤肠内营养患者营养状态的影响[J].济宁医学院学报,2026,49(3):245-251 |
| 基于循证理念的集束化护理干预对颅脑损伤肠内营养患者营养状态的影响 |
| Effect of evidence-based bundled nursing interventions on nutritional status of patients with traumatic brain injury receiving enteral nutrition |
| 投稿时间：2026-02-06 |
| DOI：10.3969/j.issn.1000-9760.2026.03.010 |
| 中文关键词: 循证理念 集束化护理 颅脑损伤肠内营养 腹泻 营养状态 |
| 英文关键词: Evidence-based practice Bundled nursing care Enteral nutrition in traumatic brain injury Diarrhea Nutritional status |
| 基金项目:开封市科技发展计划项目(2503059) |
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| 中文摘要: |
| 目的 探究基于循证理念的集束化护理干预对颅脑损伤肠内营养患者腹泻和营养状态的改善效果。方法 选取2024年1月—2025年5月,在开封市中心医院神经外科接受治疗的颅脑损伤肠内营养患者103例,随机分为对照组(52例)和观察组(51例)。对照组接受常规肠内营养护理干预,观察组在对照组的基础上采用基于循证理念的集束化护理干预,比较两组患者腹泻情况[腹泻发生率、排便性状(水样便、稀软便)、腹泻开始时间与腹泻持续时间]、神经功能指标[神经胶质纤维酸性蛋白(GFAP)、泛素羧基端水解酶-1(UCH-L1)]、营养状态(血清白蛋白、血红蛋白、血清总蛋白)及并发症发生(胃潴留、便秘、反流误吸、腹胀腹痛、恶心)情况。结果 观察组发生腹泻5(9.80%)例,腹泻开始时间(2.01±0.31)d,腹泻持续时间(3.15±0.35)d,水样便4例(7.84%),对照组发生腹泻15(28.85%)例,腹泻开始时间(1.58±0.18)d,腹泻持续时间(5.37±0.57)d,水样便12例(23.08%)。与对照组比较,观察组腹泻开始时间较晚,腹泻与水样便发生情况及腹泻持续减少,比较均具有统计学意义(t=8.629,P＜0.001;χ2=5.967,P=0.015;χ2=4.554,P=0.033;t=23.764,P＜0.001);护理后,观察组UCH-L1水平(140.64±15.57)pg/mL,GFAP水平(674.38±68.15)ng/L,对照组UCH-L1水平(192.75±21.89)pg/mL,GFAP水平(818.61±83.57)ng/L,观察组UCH-L1与GFAP均低于对照组(t=13.898,P＜0.001;t=9.588,P＜0.001);护理后,观察组血清总蛋白水平(60.61±6.57)g/L,血清白蛋白水平(41.38±4.53)g/L,血红蛋白水平(121.88±13.43)g/L,对照组血清总蛋白水平(57.75±6.89)g/L,血清白蛋白水平(37.17±4.17)g/L,血红蛋白水平(112.16±12.57)g/L,观察组血清总蛋白,血清白蛋白,血红蛋白指标均高于对照组(t=2.155,P=0.034;t=4.909,P＜0.001;t=3.793,P＜0.001);观察组并发症总发生率13.72%,对照组36.54%,观察组并发症总发生率低于对照组(χ2=7.101,P=0.008)。结论 基于循证理念的集束化护理干预用于颅脑损伤肠内营养患者的护理,可有效降低颅脑损伤肠内营养患者的腹泻发生率、减少水样便的发生、延缓腹泻、缩短腹泻时间、降低颅脑损伤肠内营养患者的脑特异性损伤因子浓度、改善颅脑损伤肠内营养患者营养状态与并发症发生情况,值得临床推广。 |
| 英文摘要: |
| Objective To investigate the effects of evidence-based bundled nursing interventions on diarrhea and nutritional status in patients with traumatic brain injury receiving enteral nutrition.Methods A total of 103 patients with traumatic brain injury receiving enteral nutrition who were treated at Neurosurgery Department,Kaifeng Central Hospital from January 2024 to May 2025 were selected and randomly divided into a control group (52 patients) and an observation group (51 patients).The control group received conventional enteral nutrition care,while the observation group received evidence-based bundled nursing interventions in addition to the standard care.The two groups were compared regarding diarrhea indicators [incidence of diarrhea,stool consistency (watery stools,loose stools),onset time, and duration of diarrhea],neurological function markers [glial fibrillary acidic protein (GFAP),ubiquitin carboxy-terminal hydrolase-1 (UCH-L1)],nutritional status (serum albumin,hemoglobin,total serum protein),and the incidence of complications (gastric stasis,constipation,aspiration,abdominal distension and pain,nausea,and overall incidence).Results Five cases (9.80%) in the observation group developed diarrhea,with a mean onset time of 2.01±0.31 days and a mean duration of 3.15±0.35 days.and watery stools occurred in 4 (7.84%) cases.In the control group,diarrhea occurred in 15 (28.85%) cases,with a mean onset time of 1.58±0.18 days and a mean duration of 5.37±0.57 days;watery stools occurred in 12 (23.08%) cases.Compared with the control group,the observation group showed a significantly longer time to onset of diarrhea,as well as significantly lower incidence of diarrhea and watery stools and shorter duration of diarrhea;all comparisons were statistically significant (t=8.629,P＜0.001;χ2=5.967,P=0.015;χ2=4.554,P=0.033;t=23.764,P＜0.001);After nursing intervention,the UCH-L1 level in the observation group was 140.64±15.57 pg/ml,and the GFAP level was 674.38±68.15 ng/L;in the control group, the UCH-L1 level was 192.75±21.89 pg/ml,and GFAP levels 818.61±83.57 ng/L.Both UCH-L1 and GFAP levels in the observation group were significantly lower than those in the control group (t=13.898,P＜0.001;t=9.588,P＜0.001);After nursing intervention,the observation group's serum total protein level was 60.61±6.57 g/L,serum albumin level was 41.38±4.53 g/L, and hemoglobin level was 121.88±13.43 g/L;the control group's serum total protein level was 57.75±6.89 g/L,serum albumin level 37.17±4.17 g/L,and hemoglobin level 112.16±12.57 g/L.The observation group's serum total protein,serum albumin,and hemoglobin levels were all significantly higher than those of the control group (t=2.155,P=0.034;t=4.909,P＜0.001;t=3.793,P＜0.001);the overall complication rate was 13.72% in the observation group and 36.54% in the control group, with the observation group showing a significantly lower overall complication rate than the control group (χ2=7.101,P=0.008).Conclusion A bundled care intervention based on evidence-based principles, when implemented to patients with traumatic brain injury receiving enteral nutrition,can effectively reduce the incidence of diarrhea,decrease the frequency of watery stools,delay the onset of the first episode of diarrhea,shorten the duration of diarrhea,lower the concentration of brain-specific injury factors in patients with traumatic brain injury receiving enteral nutrition,and improve the nutritional status and incidence of complications in these patients.This approach is worthy of clinical popularization. |
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