专科护士主导的营养管理团队在家庭肠内营养治疗中的实践

目的探讨专科护士主导的营养管理团队在家庭肠内营养治疗中的实践方法及效果。方法成立营养管理团队对26例家庭肠内营养治疗患者进行规范化管理,并由营养专科护士主导实践,对患者进行筛选后,按路径进行规范指导及培训后进行家庭肠内营养治疗,营养管理团队按规范进行监测及随访。结果 26例患者均顺利实施家庭肠内营养治疗,接受并处理患者求助19例次。治疗后2个月营养相关指标显著优于治疗前(均P0.05)。结论由专科护士主导的营养管理团队能够满足家庭肠内营养治疗患者的治疗和护理需求,符合医院发展的需要。     

多学科团队协作营养管理模式在腹膜透析患者中的应用

目的 对腹膜透析患者实施多学科协作营养管理,以改善其营养状况。方法 根据患者入院时间将首次置管行腹膜透析患者分为两组,2018年1~5月收治的42例患者为对照组,按腹膜透析管理流程实施常规护理,由腹膜透析护士负责腹膜透析治疗、营养管理、延续护理等;2019年1~5月收治的45例患者为干预组,组建多学科营养管理团队,实施多学科协作营养管理。结果 干预组出院后1个月和6个月血红蛋白、血清白蛋白、血清总铁结合力、BMI、上臂肌围及营养不良炎症评分显著优于对照组,蛋白质-能量营养不良发生率显著低于对照组（P＜0.05,P＜0.01）。结论 对腹膜透析患者进行多学科协作营养管理,能有效改善腹膜透析患者营养水平,并能够强化护士在营养管理过程中的作用。     

老年肠内营养患者项目管理法的护理实践

目的探讨项目管理法在老年患者肠内营养护理中的应用效果。方法将有营养不良风险或营养不良的老年患者216例按住院时间分为两组,观察组(108例)采用项目管理法进行营养护理,对照组(108例)采用常规方法进行营养护理。比较干预3个月后两组患者肠内营养并发症的发生情况,老年简易营养评估量表得分、血红蛋白、血清白蛋白。结果两组肠内营养并发症发生率比较,差异无统计学意义(均P 0. 05),观察组老年简易营养评估量表得分、血红蛋白、血清白蛋白显著优于对照组(P 0. 05,P 0. 01)。结论项目管理利于营养护理过程实施监测和管控,保证项目的顺利开展,提高老年患者的营养指标。     

追踪方法学在神经外科肠内营养相关性腹泻护理中的应用

目的探讨追踪方法学在神经外科肠内营养相关性腹泻预防中的应用效果。方法将240例接受肠内营养治疗的神经外科患者按入院时间顺序分成对照组和观察组各120例,两组均按常规肠内营养护理进行干预;观察组在此基础上运用追踪方法学,对肠内营养腹泻的患者实施个案追踪和系统追踪,对追踪发现的问题制定针对性改善措施并持续质量改进。结果观察组患者肠内营养相关性腹泻发生率、严重程度、持续时间显著低于/短于对照组(均P0.01);肠内营养相关性腹泻管理质量指标合格率显著高于对照组(P0.05,P0.01)。结论追踪方法学的应用有效降低了神经外科患者肠内营养相关性腹泻发生率、严重程度,缩短了持续时间,有利于提高肠内营养护理质量。     

基于“互联网+”的医院-社区-家庭三元联动健康管理模式在消化性溃疡患者中的应用

目的探讨依托"互联网+"实施医院-社区-家庭三元联动的健康管理模式对消化性溃疡患者应用效果。方法将92例消化性溃疡患者按出院时间分为对照组和观察组各46例。对照组采用常规出院随访模式;观察组组建多学科合作管理团队,采用基于"互联网+"的医院-社区-家庭三元联动健康管理模式8周。结果干预后,观察组对慢性病管理的评价,疾病症候改善情况,自我效能及满意度显著优于对照组(均P0.01)。结论基于"互联网+"的医院-社区-家庭三元联动健康管理模式可增加患者的自我能效管理,减轻疾病症状,提高满意度。     

食管癌术后家庭肠内营养患者的支持性护理干预

目的 探讨支持性护理干预在食管癌术后家庭肠内营养患者中的实施效果.方法 根据入院时间顺序将食管癌根治术后需行家庭肠内营养的190例患者分为对照组93例和干预组97例.对照组按常规进行出院指导及门诊定期复诊,干预组在对照组基础上给予支持性护理干预,比较两组出院前、出院1个月及3个月时体质量、BMI和生活质量.结果 两组体质量和BMI比较,时间效应及交互效应差异有统计学意义(均P＜0.01);干预组生活质量总分及饮食限制、反流、焦虑得分与对照组比较,干预效应、时间效应差异有统计学意义(P＜0.05,P＜0.01).结论 对食管癌术后行家庭肠内营养患者实施支持性护理干预,有利于维持食管癌术后患者体质量,改善患者症状相关生活质量.     

全息刮痧疗法对胃癌术后患者早期肠内营养耐受性的影响

目的 探讨全息刮痧疗法对胃癌术后患者早期肠内营养耐受性的影响.方法 将胃癌根治术后行肠内营养患者100例按随机数字表法分为观察组和对照组各50例.对照组按常规行肠内营养护理,观察组在肠内营养常规护理基础上,于每日首次输注肠内营养前30 min实施全息刮痧疗法.比较两组肠内营养耐受性评分、肠内营养输注达目标量时间和首次肛...     

护士主导的多学科协作鼻咽癌同步放化疗患者营养管理

目的 改善鼻咽癌患者放化疗期间的营养状况及其放化疗不良体验.方法 将74例鼻咽癌患者按住院时间分为对照组36例和观察组38例.两组均行根治性调强放疗加同期化疗,行常规临床护理;对照组实施常规营养管理,观察组实施由护士主导的多学科团队协作的营养管理.放化疗疗程完成后(7周)评价效果.结果 放化疗完成后观察组PG-SGA评...     

袋鼠肠内营养电子泵在鼻饲患者中的应用

目的观察袋鼠肠内营养电子泵在鼻饲患者中的应用效果。方法将120例老年鼻饲患者随机分为两组各60例。对照组应用普通肠内营养泵鼻饲,观察组应用袋鼠肠内营养电子泵,鼻饲3个月后对两组鼻饲效果进行比较。结果观察组鼻饲期间胃潴留、腹泻发生率显著低于对照组(P<0.05,P<0.01);其营养支持效果显著优于对照组(P<0.01)。结论应用袋鼠肠内营养电子泵控制鼻饲液输注,能有效预防鼻饲并发症发生,提高肠内营养支持的效果,促进胃肠功能恢复。     

营养支持护理专科小组的临床实践效果

目的探讨营养支持护理专科小组实践对提高营养支持护理质量的效果。方法将组建营养支持护理专科小组前后3 017例及3 104例营养支持患者作为对照组和观察组,对照组按营养支持护理常规进行护理,观察组由营养支持护理专科小组实施专业化营养支持管理措施。结果观察组肠内及肠外营养并发症发生率显著低于对照组(均P0.05);专科小组成立后1年开展营养相关的小组活动16次、肠内及肠外营养督查125例次。结论营养支持护理专科小组组建可有效提高营养支持护理质量,使患者获得更合理、安全、有效的营养支持护理。     

Polytrauma in the elderly

Twenty-seven patients over 70 years old in a consecutive series of 300 patients (mean age 75.1 years) who had sustained polytrauma were compared to a group of 27 younger patients of that series (mean age 36.1 years) and were matched for similar patterns of injuries. The injury severity scores (ISS) were nearly equal in both groups. The amount of blood transfused, the shock index on arrival, the number of peritoneal lavages performed, and the number of chest drains inserted were similar in both groups. In general, the trauma-causing injury in the older patients was substantially less severe than in the younger age group. Nearly all fractures were treated operatively in the younger patients, while equivalent fractures in the older group were more often treated conservatively. The greater mortality in the older patients was due to preexisting handicaps, which are disregarded by the ISS. Most of the older patients who survived could be satisfactorily rehabilitated. What causes and what are the injuries of the elderly polytrauma patient? How aggressive should the treatment be and to what degree is rehabilitation of survivors possible?     

Tumors in the elderly

The prevalence and incidence of cancer are age related; increased longevity thus increases the number of elderly patients with cancer. Only a few data suggest that en bloc radical cystectomy in patients with bladder cancer and radical prostatectomy in patients with prostate cancer can be safely performed on properly selected elderly patients (aged 70 years or older) with results comparable to those for younger patients. Due to the physiologic decline in renal function and hepatic drug metabolism in old age, chemotherapeutic agents show increasing toxicity in the elderly. The elderly remain underrepresented in clinical trials. In the absence of comprehensive data on treatment in the elderly, the belief persists that the elderly derive less benefit and suffer greater toxic effects from chemotherapy than younger patients.     

Trauma in the elderly

One hundred geriatric patients who suffered injury severe enough to necessitate hospitalization were compared retrospectively to a random group of 100 younger patients. The elderly suffered different types of injury and died six times as often as their younger peers, even when controlled for injury severity. The PRE method was employed to examine outcome in both groups and was found to be strongly predictive of death in young patients. Age stratification aided significantly in predicting mortality in elderly patients. Regression analysis was employed to examine the data set to determine the relative importance of several variables in the prediction of ultimate mortality. By incorporating all the data from the entire data set, curves describing the contribution of age and shock to mortality corrected for all factors is possible. Increasing age after 65 increases mortality and this effect is dramatically increased by the presence of shock. This information may be useful in counselling the injured elderly and their families.     

Pharmacodynamics in the elderly

An overview is given of the influence of age on the pharmacodynamics of drugs used during general and locoregional anaesthesia. For some groups of agents a distinct separation into age-related changes in the pharmacokinetics and pharmacodynamics is possible, whereas for others the literature indicates only that responses in the elderly are enhanced. I start with an overview of the influence of age on cardiovascular and neuroendocrine function and include a short account of the state-of-the-art in pharmacodynamic modelling. The physiological changes that occur with age are associated with an increased sensitivity to the effects of anaesthetic agents. For most intravenous hypnotic agents, and inhalational anaesthetic agents, the increased sensitivity with age is, at least in part, explained by altered pharmacodynamics. For opioids and local anaesthetics applied for blockade of the central nervous system, the pharmacodynamic involvement is not always clear. For neuromuscular blocking agents, pharmacodynamic involvement appears to be nearly absent in the reduced dose requirements seen with age--so that the latter appear to be caused by altered pharmacokinetics. Future studies, using pharmacokinetic-pharmacodynamic (PK-PD) mixed-effects modelling, should further explore this area to obtain clinically applicable data for improving our insight into the delivery of anaesthetics to the elderly and improving the quality of anaesthesia in this fast-growing population.     

Sexuality of the elderly

Partial androgen deficiency of the aging male is associated with symptoms collectively accepted as the andropause syndrome. The underlying hormonal changes, the definition of age-dependent cofactors for changing sexuality, and the data on decreasing erectile function are the main topics of this critical analysis. Alterations in libido, ejaculation and sperm quality also have to be considered in order to define a change in male sexuality as part of the natural process of aging.     

Pharmacokinetics in the elderly

The elderly are an expanding population of patients presenting for anaesthesia. The pharmacokinetics of anaesthetic agents in the elderly deserves special attention because the normal ageing process and the effect of age-related diseases affect organ systems in a heterogeneous way with unpredictable consequences. The pharmacokinetics of each drug is also affected by these changes in a specific way and, together with the pharmacodynamic consequences, makes drug use and drug dosing challenging in this population. Although a decrease in bolus and infusion rates is a common theme, only pharmacokinetic modelling of drug disposition in the elderly will provide accurate dosing guidelines and increase the margin of safety.