质量改善倡议使用预测吞得分来指导脑卒中后缺食症患者的营养支持
Amr Jijakli1, Katelyn Skeels1, Devin Zebelean1
1Division of Stroke and Cerebrovascular Diseases (AJ, K. Skeels, DZ, AL, EM, LYL), Department of Neurology; Department of Speech Language Pathology (K. Swanson), Tufts Medical Center; Department of Neurology (BD), Boston Medical Center, MA; Department of Rehabilitation Medicine (AS), Tufts Medical Center, Boston; and Encompass Health Rehabilitation Hospitals (BD, AS), MA.
在急性缺血性中风患者中,一种用于肠道营养的新算法改善了胃口安置的决策时间. 这种方法促进了早期的干预,但没有增加胃口术的总体使用率.
科学领域:
- 神经学 神经学
- 胃肠病学 胃肠病学
- 提高质量 提高科学 提高质量
背景情况:
- 在急性缺血性中风 (AIS) 后的消化不良症患者的肠道营养决定往往缺乏基于证据的指导方针.
- 预测吞分数 (PRESS) 可以帮助评估吞功能.
研究的目的:
- 评估使用PRESS的营养支持算法是否可以改善AIS患者肠道营养的处理时间.
- 确定算法是否减少了不必要的胃口腔安置.
主要方法:
- 一项质量改进研究比较了两组AIS患者的6个月的消化不良.
- 收集的数据包括胃口术建议,决定时间 (TTD),排出方法 (胃口术或鼻胃管 - NGT) 和停留时间 (LOS).
- 队列是营养支持算法实施前和后的队列.
主要成果:
- 后算法队列显示,胃口术决定的时间显著缩短 (1.5天对4.5天,p=0.004).
- 胃口切除术的安置频率在各组之间保持相似 (8%对12%).
- 建议胃口术的患者在后算法组的逗留时间较短 (6.5天对14.5天,p=0.03).
结论:
- 结合PRESS的结构化营养支持算法可以加快胃口腔安置决策.
- 该算法可以促进及时的干预,而不会增加胃口术率.
- 它还可能鼓励通过鼻胃管排放到住院康复设施.
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