营养支持方案对压疮患者的疗效：方案前后比较。
Efficacy of nutritional support protocol for patients with pressure ulcer: comparison of before and after the protocol.
机构信息
Department of Critical Care Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Department of Critical Care Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
出版信息
Nutrition. 2022 Jul-Aug;99-100:111638. doi: 10.1016/j.nut.2022.111638. Epub 2022 Feb 24.
OBJECTIVES
Because most patients who develop pressure ulcer (PU) are malnourished, additional nutritional support is important for PU improvement. The aim of this study was to investigate the potential benefit of a simple nutritional support protocol in PU improvement.
METHODS
This study was a comparative before-and-after study, prospectively performed from May to December 2020. Participants were inpatients of Seoul National University Hospital (SNUH), South Korea. Among the patients who developed PU from May to December 2020, those on enteral nutrition were included in the protocol group. Application of the nutritional support protocol was established in May 2020 in SNUH. Serum levels of prealbumin, transferrin, cholesterol, and zinc were measured initially and 2 and 4 wk after protocol application to evaluate clinical course. A tailored regimen that adjusted the amount of protein and trace elements was provided according to consultation with the nutritional support team. Size and Pressure Ulcer Scale for Healing was evaluated every 2 wk by the same nurse in charge of PU. To validate the efficacy of the protocol, patients who developed PU from May to December 2018, were hospitalized for >2 wk, and who received enteral nutrition were selected as a control group.
RESULTS
Sixty-one patients were included in the protocol group and 100 were in the control group. The protocol group had a higher proportion of PU improvement (85.2 versus 50%; P < 0.001), daily protein intake (1.6 ± 3.2 versus 0.9 ± 0.4; P = 0.048), Braden scale (12.9 ± 1.8 versus 12.3 ± 1.8; P = 0.025), and baseline albumin level (3.1 ± 0.5 versus 2.8 ± 0.4; P = 0.001) when compared with the control group. Multivariate analysis showed that implementation of the nutritional support protocol was the most effective factor in improving PU (odds ratio, 0.18; 95% confidence interval, 0.089-0.366; P < 0.001).
CONCLUSIONS
A simple nutritional support protocol was easy to develop and its application contributed significantly to the recovery of PU.
目的
由于大多数发生压疮（PU）的患者都存在营养不良，因此额外的营养支持对改善 PU 非常重要。本研究旨在探讨简单营养支持方案对改善 PU 的潜在益处。
方法
这是一项比较性的前后对照研究，于 2020 年 5 月至 12 月期间前瞻性进行。参与者为韩国首尔国立大学医院（SNUH）的住院患者。在 2020 年 5 月至 12 月期间发生 PU 的患者中，纳入接受肠内营养的患者进入方案组。SNUH 于 2020 年 5 月开始实施营养支持方案。最初以及方案应用后 2 周和 4 周测量血清前白蛋白、转铁蛋白、胆固醇和锌的水平，以评估临床病程。根据与营养支持团队的咨询，提供了调整蛋白质和微量元素量的定制方案。负责 PU 的同一名护士每 2 周评估一次大小和压疮愈合量表。为了验证方案的疗效，选择了 2018 年 5 月至 12 月期间住院时间超过 2 周且接受肠内营养的发生 PU 的患者作为对照组。
结果
方案组纳入 61 例患者，对照组纳入 100 例患者。方案组的 PU 改善比例更高（85.2%对 50%；P<0.001），每日蛋白质摄入量更多（1.6±3.2 对 0.9±0.4；P=0.048），Braden 量表评分更高（12.9±1.8 对 12.3±1.8；P=0.025），白蛋白基线水平更高（3.1±0.5 对 2.8±0.4；P=0.001）。与对照组相比。多变量分析显示，实施营养支持方案是改善 PU 的最有效因素（比值比，0.18；95%置信区间，0.089-0.366；P<0.001）。
结论
简单的营养支持方案易于制定，其应用对 PU 的恢复有显著贡献。
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