Objective To explore the effect of processized nutrition treatment strategy on the clinical efficacy of critically ill patients.Methods A prospective study was conducted, and 195 patients admitted to Department of Intensive Care Unit of Jiaxing Second Hospital from July 2016 to February 2017 were enrolled. From July to September 2016, 94 cases were assigned in the control group, and they were given the routine nutritional treatment program. From October to November 2016, the training of processized nutrition treatment strategy was carried out and improved according to plan-do-check-act (PDCA) cycle management plan, From December 2016 to February 2017, 101 cases were assigned in the observation group and treated by the doctor and nurse processized nutrition treatment strategy. The differences of early enteral nutrition (EEN) ratio, the time reaching standard of enteral nutrition (EN) in two group were compared, the incidence of complications related to EN, mechanical ventilation time, ICU hospitalization time, ICU expense and mortality were observed between the two groups.Results Compared with the control group, the ratio of EEN was significantly increasedin the observation group [90.1% (91/101) vs. 47.9% (45/94)], the time reaching standard of EN shortened (days: 5.18±1.43 vs. 6.47±1.95), the incidences of gastrointestinal tract related complications [0.77% (9/1173) vs. 1.67% (22/1319)] and ventilator associated pneumonia [VAP: 4.90‰(4/816) vs. 15.32‰(16/1044)] were obviously decreased, ICU hospitalization time (days:11.61±5.93 vs. 14.03±8.27), mechanical ventilation time (days: 8.08±6.16 vs. 11.11±7.87), the mortality [23.76% (24/101) vs. 31.91% (30/94)] were significantly reduced in the observation group (allP < 0.05), but the ICU hospitalization expenses had no significant difference in observation group and control group (millions: 7.26±7.23 vs. 7.07±4.60,P > 0.05).Conclusions The processized nutrition treatment strategy can improve the EEN implementation rate of critically ill patients, help to establish EN as early as possible, reduce the incidence of gastrointestinal and pulmonary infections and other complications.%目的 探讨流程化营养治疗策略对急危重症患者临床疗效的影响.方法 采用前瞻性研究方法,选择2016年7月至2017年2月嘉兴市第二医院重症医学科(ICU)收治的195例患者为研究对象.将2016年7月至9月收治的94例患者作为对照组,给予常规营养治疗方案.2016年10月至11月进行流程化营养治疗策略培训并按PDCA循环管理方案〔计划(P)、实施(D)、检查(C)、行动(A)〕进行改进,将2016年12月至2017年2月收治的101例患者作为观察组,医护按流程化营养策略进行治疗.比较两组早期肠内营养(EEN)比例和达标时间的差异,并观察两组肠内营养(EN)相关并发症发生情况、机械通气时间、ICU住院时间、ICU住院费用、病死率.结果 与对照组比较,观察组EEN比例显著提高〔90.1%(91/101)比47.9%(45/94)〕,EN达标时间缩短(d:5.18±1.43比6.47±1.95),消化道相关并发症的发生率〔0.77%(9/1173)比1.67%(22/1319)〕及呼吸机相关性肺炎(VAP)发生率〔4.90‰(4/816)比15.32‰(16/1044)〕均明显降低,ICU住院时间(d:11.61±5.93比14.03±8.27)、机械通气时间(d:8.08±6.16比11.11±7.87)、病死率〔23.76%(24/101)比31.91%(30/94)〕均减少(均P<0.05),但观察组和对照组ICU住院费用比较差异无统计学意义(万元:7.26±7.23比7.07±4.60,P>0.05).结论 流程化营养治疗策略可提高危重症患者的EEN执行率,有助于尽早建立EN,减少胃肠道并发症及肺部感染的发生率.
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