| Research Purpose:Research to reduce back to draw the frequency of gastric contents and prophylactic use of acupuncture respectively in patients with severe feeding tolerance and the effects of nutritional status,and study the effect of combining both feeding in patients with severe condition,to improve the patient’s feeding conditions,improve the feeding success rate,improve the clinical nursing work efficiency and provide new way to improve feeding in patients with severe situation.Research Methods:This study is a randomized controlled study.154 critically ill patients admitted to the intensive care department of a tertiary hospital in Huzhou from December 2019 to February 2021 were selected as the research objects.The patients were divided into 4 groups using a random number table method,of which A there were 38 people in group,38 people in group B,39 people in group C,and 39 people in group D.The 2*2 factorial design was adopted as the research design method.The 4 groups of patients all received symptomatic treatment and nursing routine.In group A,gastric contents were withdrawn at normal frequency,within 24 to 48 hours after admission,the patients receive enteral nutrition therapy.The gastric contents were withdrawn every 4h to monitor the gastric residual volume(Q4h),and feeding strategies were adjusted in combination with the feeding tolerance rating scale.Compared with group A,group B reduced the withdrawal frequency from once every 4h to once every 12h(Q12h),and the other measures were the same as group A.Group C is the routine retraction frequency combined with acupuncture group.On the basis of group A,preventive acupuncture combined with electroacupuncture and simple acupuncture was given on the first day of enteral nutrition.Electroacupuncture points were bilateral Zusanli and Shangjuxu,continuous wave,with a frequency of 4MHz,Bilateral Neiguan,Zhongwan,bilateral Tianshu and Qihai were simply acupuncture,for consecutive 7 days,once a day,and 20 min was retained each time.In group D,preventive acupuncture was used on the basis of group B for the combined acupuncture group to reduce the frequency of withdrawal,the acupuncture strategy was the same as that of group C.After 7 days,the incidence of feeding intolerance,the incidence of feeding interruption due to feeding intolerance,the proportion of feeding target on the 7th day,daily feeding amount in the 4 groups and acupuncture related adverse reactions were observed.Research Results:(1)In terms of feeding tolerance and feeding interruption,the statistical analysis of the four groups showed that,compared with the conventional regurgitation frequency,the incidence of abdominal distension,diarrhea,vomiting and feeding interruption due to feeding intolerance was not significantly affected by reducing the frequency of suction of gastric contents(P>0.05).The incidence of abdominal distension(P=0.002),diarrhea(P=0.007),vomiting(P=0.028)and feeding interruption(P=0.008)in patients with prophylactic acupuncture was significantly lower than that in patients without prophylactic acupuncture(P<0.05);Introducing their interaction term,prophylactic application of acupuncture and reduction of retraction frequency had no interaction effect on the incidence of feeding intolerance and feeding interruption in patients(P>0.05).(2)In terms of feeding compliance rate and feeding amount,reducing the frequency of withdrawal(P=0.026)and preventive acupuncture(P=0.008)can increase the patient’s 7th day feeding compliance rate(P<0.05),but the combination of the two has no interaction in the feeding compliance rate(P>0.05).The results of the analysis of variance on the daily feeding amount of the four groups showed that there was no interaction between the reduction of withdrawal frequency and the combination of preventive acupuncture in the first 3 days of feeding(P>0.05),and the main effect of the withdrawal frequency was not significant(P>0.05).On the second to third days of feeding,the main effect of preventive acupuncture was significant(feeding day 2P=0.033,feeding day3 P=0.000),and could significantly increase the patient’s feeding amount(P<0.05).On the 4th to 7th day of feeding,the combined application of reducing the frequency of withdrawal and preventive acupuncture had a significant interaction,and it was a synergistic effect(P<0.05).(3)To investigate the separate effects of the two,under the premise of using acupuncture,compared with Q4h withdrawing the gastric contents,the patient’s feeding amount on the 4th to 7th days was higher when the stomach contents were withdrawn at Q12h(P<0.05).Under the premise of using acupuncture,reducing the frequency of withdrawal has no significant effect on the feeding amounts of patients on the 4th to 5th day,and the feeding amount on the 6th to 7th day is significantly higher than that of the routine frequent withdrawal group(P<0.05).On the premise that the gastric contents were withdrawn at Q12h,compared with not using acupuncture,the patient’s feeding amount was higher on the 4th to 7th day when acupuncture was used(P<0.05).Under the premise of the gastric contents withdrawn at Q4h,compared with not using acupuncture,the patient’s feeding amount on the 6th to 7th day was higher when using acupuncture(P<0.05),but the feeding amount of the patient on the 4th to 5th day could not be significantly increased.(4)During the study period,patients did not occur aspiration and acupuncture related adverse.Research Conclusion:(1)Reducing the frequency of regurgitating gastric contents will not bring harm to patients with enteral nutrition,and can increase the amount of feeding and the proportion of feeding standards,improve the nutritional status of patients,and improve the efficiency of nursing work;(2)Preventive application of acupuncture can significantly reduce the incidence of feeding intolerance,increase the amount of feeding,and improve the nutritional status of patients,and patients did not have adverse reactions,it is a safe measure;(3)The combined application of reducing the frequency of regurgitation of gastric contents and prophylactic acupuncture has a synergistic effect on the amount of feeding of patients,which can significantly increase the amount of feeding of patients,and the effect is significantly better than that of the group of simply reducing the frequency of regurgitation and simply applying acupuncture.The combined application of the two is worthy of clinical promotion. |
PDF Full Text Request