针对性医师教育有利于营养疗法实施和患者结局：前瞻性临床研究结果

　　背景：营养不良一直常见于住院患者。我们推测针对性医师教育有助于减少热量缺乏并改善患者结局。

　　资料与方法：我们将患者（n=121）分为2组进行了一项前瞻性试验。实验组（EG）接受了包括增加早期肠内营养在内的针对性教育。具体策略包括早期肠内营养、避免禁食（NPO）以及清淡流质饮食（CLD）、定量喂养、术后早期恢复喂养、记录热量缺乏程度。对照组（CG）不接受针对性教育但允许其以自己选择的标准进行临床处理。根据规范标准，多学科营养团队给两组患者均提供营养建议。

　　结果：与CG组相比，EG组热量达标率较高（30.1±18.5%，22.1±23.7%，P=0.024）。两组缺乏热量的平均程度的差异无统计学显著性（-6796±4164kcal比-8817±7087kcal，P=0.305）。与CG组相比，EG组每例患者CLD天数（0.1±0.5比0.6±0.9）、住重症监护病房天数（3.5±5.5比5.2±6.8）以及机械通气天数（1.6±3.7比2.8±5.0）均有所缩短（P＜0.05）。与CG组相比，EG组患者的院内感染较少（10.6%比23.6%）且器官衰竭较少（10.6%比18.2%），但是这些差异未达统计学显著性。

　　结论：实施针对性教育策略对开展营养疗法取得较大成功，并有利于患者的诊疗和结局。

JPEN J Parenter Enteral Nutr. 2015 Nov;39(8):948-52.

Targeted Physician Education Positively Affects Delivery of Nutrition Therapy and Patient Outcomes: Results of a Prospective Clinical Trial.

Hurt RT, McClave SA, Evans DC, Jones C, Miller KR, Frazier TH, Minhas MA, Lowen CC, Stout A, Edakkanambeth Varayil J, Matheson PJ, Franklin GA.

Mayo Clinic, Rochester, Minnesota.

University of Louisville School of Medicine, Louisville, Kentucky.

Ohio State University, Columbus, Ohio.

BACKGROUND: Malnutrition is a continuing epidemic among hospitalized patients. We hypothesize that targeted physician education should help reduce caloric deficits and improve patient outcomes.

MATERIALS AND METHODS: We performed a prospective trial of patients (n = 121) assigned to 1 of 2 trauma groups. The experimental group (EG) received targeted education consisting of strategies to increase delivery of early enteral nutrition. Strategies included early enteral access, avoidance of nil per os (NPO) and clear liquid diets (CLD), volume-based feeding, early resumption of feeds postprocedure, and charting caloric deficits. The control group (CG) did not receive targeted education but was allowed to practice in a standard ad hoc fashion. Both groups were provided with dietitian recommendations on a multidisciplinary nutrition team per standard practice.

RESULTS: The EG received a higher percentage of measured goal calories (30.1 ± 18.5%, 22.1 ± 23.7%, P = .024) compared with the CG. Mean caloric deficit was not significantly different between groups (-6796 ± 4164 kcal vs -8817 ± 7087 kcal, P = .305). CLD days per patient (0.1 ± 0.5 vs 0.6 ± 0.9), length of stay in the intensive care unit (3.5 ± 5.5 vs 5.2 ± 6.8 days), and duration of mechanical ventilation (1.6 ± 3.7 vs 2.8 ± 5.0 days) were all reduced in the EG compared with the CG (P < .05). EG patients had fewer nosocomial infections (10.6% vs 23.6%) and less organ failure (10.6% vs 18.2%) than did the CG, but these differences did not reach statistical significance.

CONCLUSION: Implementation of specific educational strategies succeeded in greater delivery of nutrition therapy, which favorably affected patient care and outcomes.

KEYWORDS: enteral nutrition; nutrition; nutrition support practice; nutrition support teams; outcomes research/quality

PMID: 24997175

DOI: 10.1177/0148607114540332