标题：N-MDT诊疗模式在急性胰腺炎患者肠内营养管理中的应用

      作者：冯燕，常婧，黄凡    冯燕，常婧，黄凡陕西省人民医院消化内一科，陕西 西安 710068

      卷次： 2023年34卷18期

      【摘要】 目的 探究基于以护士为主导的多学科诊疗模式(N-MDT)在急性胰腺炎患者肠内营养管理中的应用价值。方法 回顾性分析 2019年 6月至 2021年 10月陕西省人民医院收治的 100例急性胰腺炎患者的临床资料。将2019年6月至2020年10月期间实施常规诊疗模式的50例急性胰腺炎患者作为对照组，2020年11月至2021年10月期间实施N-MDT诊疗模式的50例患者作为观察组。比较两组患者肠内营养管理效果，同时比较两组患者干预前、干预5 d后的炎性因子[血清降钙素原(PCT)、高敏C反应蛋白(hs-CRP)、白细胞介素1 (IL-1β)、白细胞介素22 (IL-22)]和肠内营养指标[白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF)、纤维蛋白原(FIB)]；采用生活质量评分量表(SF-36)评价两组患者干预前、干预5d后的生活质量；比较两组患者脓毒血症、肺部感染等并发症发生情况；随访1年，比较两组患者的预后情况；自制问卷调查两组患者对护理的满意度。结果 观察组患者的 ICU驻留时间、住院时间分别为(5.45±1.42) d、(13.11±2.23) d，明显短于对照组的(7.37±2.33) d、(16.53±2.39) d，差异均有统计学意义(P<0.05)；干预5 d后，观察组患者的临床治疗总有效率为94.0%，明显高于对照组的68.0%，差异有统计学意义(P<0.05)；干预前，两组患者的PCT、hs-CRP、IL-1β、IL-22水平比较差异均无统计学意义(P>0.05)，干预5 d后，两组患者的上述各项指标均逐渐降低，且观察组患者的降低幅度更大，分别为(2.45±0.44) μg/L、(8.23±2.08) mg/L、(0.21±0.04) pg/mL、(7.49±1.35) μg/mL，明显低于对照组的(4.84±1.21) μg/L、(12.03±2.25) mg/L、(0.35±0.06) pg/mL、(10.34±1.46) μg/mL，差异均有统计学意义(P<0.05)；干预前，两组患者的ALB、PA、TRF、FIB水平比较差异均无统计学意义(P>0.05)，干预 5 d后，两组患者的上述各指标均降低，且观察组患者的降低幅度更大，分别为(23.33±2.05) g/L、(139.34±10.17) mg/L、(1.76±0.15) g/L、(3.49±0.35) g/L，明显低于对照组的(31.24±2.11) g/L、(168.17±11.21) mg/L、(2.83±0.42) g/L、(5.34±1.46) g/L，差异均有统计学意义(P<0.05)；干预前，两组患者的生活质量各维度评分比较差异均无统计学意义(P>0.05)，干预后，两组患者的上述指标均逐渐提高，且观察组提高幅度更大，差异均有统计学意义(P<0.05)；观察组并发症总发生率及再入院率、死亡率分别为4.0%、0、4.0%，明显低于对照组的20.0%、6.0%、22.0%，差异均有统计学意义(P<0.05)；观察组患者的护理满意度问卷得分为(94.26±4.66)分，明显高于对照组的(88.53±5.45)分，差异有统计学意义(P<0.05)。结论 N-MDT诊疗模式应用于急性胰腺炎患者相较于常规诊疗模式肠内营养管理效果更显著，有利于缓解患者炎性反应，提高肠内营养代谢水平，改善患者生活质量，降低并发症发生风险，同时有助于提高护理工作效率和患者满意度。
      【关键词】 以护士为主导的多学科诊疗模式；超敏C反应蛋白；血清前白蛋白；急性胰腺炎；纤维蛋白原；生活质量
      【中图分类号】 R473.6 【文献标识码】 A 【文章编号】 1003—6350（2023）18—2726—06

Application of nurse-led multidisciplinary team diagnosis and treatment model in enteral nutrition managementin patients with acute pancreatitis.
FENG Yan, CHANG Jing, HUANG Fan. The First Department of Gastroenterology,Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, CHINA
【Abstract】 Objective To explore the application value of nurse-led multidisciplinary team (N-MDT) diagnosisand treatment model in enteral nutrition management in patients with acute pancreatitis. Methods The clinical data of100 patients with acute pancreatitis admitted to Shaanxi Provincial People's Hospital from June 2019 to October 2021were retrospectively analyzed. Fifty patients with acute pancreatitis who received conventional diagnosis and treatmentmode from June 2019 to October 2020 were selected as the control group, and 50 patients who received N-MDT diagno-sis and treatment model from November 2020 to October 2021 were selected as the observation group. The effect of en-teral nutrition management were compared between the two groups. The inflammatory factors [serum procalcitonin(PCT), high-sensitivity C-reactive protein (hs-CRP), interleukin-1 (IL-1β), interleukin-22 (IL-22)] and enteral nutritionindexes [albumin (ALB), prealbumin (PA), transferrin (TRF) and fibrinogen (FIB)] of the two groups were compared be-fore intervention and 5 days after intervention. Quality of life scale (SF-36) was used to evaluate the quality of life be-tween the two groups before and 5 days after intervention. The occurrence of complications such as sepsis and pulmonaryinfection were compared between the two groups. The patients were followed up for 1 year, and the prognosis of the twogroups were compared. Self-made questionnaire was used to investigate the satisfaction of the two groups of patients withnursing. Results The length of ICU stay and length of hospital stay in the observation group were (5.45±1.42) d and(13.11±2.23) d, respectively, which were significantly shorter than (7.37±2.33) d and (16.53±2.39) d in the control group(P<0.05). After 5 days of intervention, the total clinical effective rate in the observation group was 94.0%, which wassignificantly higher than 68.0% in the control group (P<0.05). Before intervention, there was no statistically significantdifference in PCT, hs-CRP, IL-1β and IL-22 between the two groups (P>0.05). After 5 days of intervention, the indexesof the two groups gradually decreased, and the differences within the group were statistically significant (P<0.05); the de-crease of observation group was greater, which were (2.45±0.44) μg/L, (8.23±2.08) mg/L, (0.21±0.04) pg/mL, (7.49±1.35) μg/mL, significantly lower than (4.84±1.21) μg/L, (12.03±2.25) mg/L, (0.35±0.06) pg/mL, (10.34±1.46) μg/mL inthe control group (P<0.05). Before intervention, there was no statistically significant difference in ALB, PA, TRF, and FIBlevels between the two groups (P>0.05). After 5 days of intervention, the above indexes of the two groups decreased, andthe decrease of the observation group was greater, which were (23.33±2.05) g/L, (139.34±10.17) mg/L, (1.76±0.15) g/L,(3.49±0.35) g/L, significantly lower than (31.24±2.11) g/L, (168.17±11.21) mg/L, (2.83±0.42) g/L, (5.34±1.46) g/L inthe control group (P<0.05). Before the intervention, there was no statistically significant difference in the scores of eachdimension of quality of life between the two groups (P>0.05). After intervention, the above indexes of the two groupsgradually increased, and the observation group increased more, with statistically significant differences (P<0.05). The to-tal incidence of complications, readmission rate, and mortality rate in the observation group were 4.0%, 0, and 4.0%, re-spectively, which were significantly lower than 20.0%, 6.0%, and 22.0% in the control group (P<0.05). The nursing satis-faction questionnaire score in the observation group was (94.26 ± 4.66) points, which was significantly higher than(88.53±5.45) points in the observation group (P<0.05). Conclusion Compared with conventional diagnosis and treat-ment mode, N-MDT treatment mode has more significant effect on enteral nutrition management in patients with acutepancreatitis, which is beneficial to alleviate the inflammatory response of patients, improve the level of enteral nutritionmetabolism, improve the quality of life of patients, and reduce the risk of complications, and at the same time to improvethe efficiency of nursing work and improve patient satisfaction.
      【Key words】 Nurse-led multidisciplinary team diagnosis and treatment model; High-sensitivity C-reactive pro-tein; Serum prealbumin; Acute pancreatitis; Fibrinogen; Quality of life