Investigation On Status Of Enteral Nutrition Support In Patients With Severe Stroke In Neurological Intensive Care Units In Northeast China

Background and Object: At present,there is no relevant data about the implementation of 《Chinese Consensus on Enteral Nutrition in Neurology》 in NICU in Northeast China.The purpose of this study is to investigate the correct implementation rate of the operational items in the Consensus and evaluate the compliance of health care workers caring patients with severe stroke in NICU in Northeast China.At the same time,we will analyze whether the correct execution of each item is a factor influencing the hospitalization time in NICU for patients with severe stroke.Patients and Method: From December 2016 to December 2017,30 patients with severe stroke were involved in each NICU in six grade iii-A hospitals paticipating in this study.The basic information,disease status,enteral nutrition support operations and hospitalization time in NICU of the patients were recorded by the clinical medical staff.With reference to the 2011 edition of Consensus,each item of enteral nutrition support in each case will be evaluated.Items violating the principle of the Consensus or failure to complete the recommendation of the Consensus will be identified as wrong,otherwise they will be considered correct.The identification will be conducted by a team member(neurologist).Another team member(neurologist)will conduct a statistical analysis of all the information above to investigate the status of enteral nutrition support in patients with severe stroke in NICU in Northeast China.At the same time,we will analyze whether the correct execution of each item is a factor influencing the hospitalization time in NICU for patients with severe stroke.With the help of software SPSS22.0,the counting data will be compared by chi-square test,and the count data regression analysis will be conducted by multivariate Logistic regression analysis.Results: 1.The status of enteral nutrition support in patients with severe stroke in NICU in Northeast China.The correct rates of enteral nutrition support items from high to low are: blood lipids monitoring(99.4%),serum protein monitoring(99.4%),nutrition infusion route selection(98.3%),enteral nutrition starting time(96.5%),digestive tract symptom monitoring(96.5%),nutrition pipeline selecting(94.8%),stop of enteral nutrition support evaluating(89%),nutrition risk screening(81.4%),depth monitoring of feeding tube (81.4%),bedside elevation(78.5%),volume of liquid took in and discharged monitoring(75.6%),blood glucose monitoring(72.7%),gastric residual liquid detection monitoring(70.9%),washing pipe with warm water(63.4%),energy supply target(61.6%),serum electrolyte monitoring(59.9%),capacity from less to more(52.9%),speed from slow to fast(45.9%),nutritional formula selection(37.8%),body mass monitoring(11%).Items with higher accuracy and statistical significance compared with Beijing Xuanwu Hospital’s data before training include: nutritional risk screening(P<0.001),energy supply target(P=0.02),bedside elevation(P<0.001),blood lipids monitoring(P=0.035).Items with lower accuracy and statistical significance compared with Beijing Xuanwu Hospital’s data before training include: capacity from less to more(P<0.001),speed from slow to fast(P=0.059),washing pipe with warm water(P<0.001),body mass monitoring(P<0.001),blood glucose monitoring(P<0.001),volume of liquid took in and discharged monitoring(P<0.001),serum electrolyte monitoring(P=0.002),depth of feeding tube monitoring(P=0.001),gastric residual fluid monitoring(P<0.001),stop of enteral nutrition support evaluating(P=0.009).Items with higher accuracy and statistical significance compared with Beijing Xuanwu Hospital’s data after training include: energy supplytarget(P < 0.013),blood lipids monitoring(P < 0.001),serum protein monitoring(P < 0.001).Items with lower accuracy and statistical significance compared with Beijing Xuanwu Hospital’s data after training include: nutritional formula selection(P=0.01),bedside elevation(P=0.001),capacity from less to more(P=0.001),speed from slow to fast(P<0.001),washing pipe with warm water(P<0.001),body mass monitoring(P<0.001),blood glucose monitoring(P<0.001),volume of liquid took in and discharged monitoring(P<0.001),serum electrolyte monitoring(P < 0.001),depth of feeding tube monitoring(P=0.002),gastric residual fluid monitoring(P<0.001),stop of enteral nutrition support evaluating(P=0.016).2.Screening of factors influencing the hospitalization time in NICU for patients with severe stroke Energy supply targets(OR=0.463,95%CI: 0.234-0.916,P=0.027),stop of enteral nutrition support evaluating(OR=0.160,95%CI: 0.043-0.605,P=0.007)are independent factors influencing the hospitalization time in NICU for patients with severe stroke.Conclusions: 1.At present,the items of operation of enteral nutrition support in NICU of grade iii-A hospitals in Northeast China needs to be improved,especially capacity from less to more,speed from slow to fast,nutritional formula selection and body mass monitoring.2.Energy supply targets and stop of enteral nutrition support evaluating are independent factors influencing the hospitalization time in NICU for patients with severe stroke.3.Medical staffs in NICU in six grade iii-A hospitals in Northeast China should receive intensive training in enteral nutrition support so as to improve the correct implementation rate of the "consensus" project,reduce the hospitalization time and maximize the benefits of the patients.