| Objective:To explore the application effect of the intervention scheme of nurse-led multi-disciplinary team(MDT)mode in diarrhea,nutritional status,neurological function,activities of daily living,incidence of secondary complications,hospitalization time and hospitalization costs of stroke patients with enteral nutrition via nasogastric tube,in order to provide some reference for clinical application and promotion of nurse-led MDT mode.Methods:1.In this study,through literature analysis,semi-structured interviews,expert meetings,and pre-trial methods,formulate a nurse-led MDT mode enteral nutrition intervention plan,and to verify its effectiveness.2.This study adopts randomized controlled trial study design.From April 2021 to November 2021,127 stroke patients who met the inclusion and exclusion criteria and received enteral nutrition via nasogastric tube in the neurology department of a tertiary hospital in Shanxi Province were selected as the research subjects.According to the order of admission,the patients were randomly divided into the control group and the intervention group.There were 63 cases in the control group,and routine intervention was used.There were 64 cases in the intervention group,on the basis of the routine intervention program,the nurse led,combined with the neurology department,nutrition department,rehabilitation department and traditional Chinese medicine department to form a multidisciplinary team to implement the multidisciplinary collaborative intervention program.The following indicators were compared between the two groups of patients: the incidence of diarrhea and incontinence-associated dermatitis;the serum albumin,serum total protein and hemoglobin levels before,at day 7 and day 14 of nutritional therapy;At admission and discharge,patients were evaluated for nutritional risk screening scores,National Institutes of Health Stroke Scale scores,and Barthel Index scores;the incidence of secondary complications during hospitalization;hospitalization time and hospitalization costs.Results:1.Comparison of general data between the two groups: age,gender,clinical diagnosis,education level,per capita monthly household income and disease-related information of patients in the intervention and control groups were not statistically significant(P>0.05),and were comparable at baseline.2.Comparison of diarrhea between two groups of patients: the incidence,duration and severity of diarrhea in the intervention group were lower than those in the control group,with statistically significant differences(P<0.05).3.Comparison of two groups of patients with incontinence-associated dermatitis: in terms of incidence,the patients in the intervention group were lower than those in the control group,with statistically significant differences(P<0.05);for the comparison of their gradations,there was no statistical significance between the two groups of patients(P>0.05).4.Comparison of nutritional status between the two groups:(1)The results of intra-group comparison showed that the NRS-2002 scores of the two groups of patients at discharge were lower than those at admission,with statistically significant differences(P<0.05).The results of the between-group comparison showed that at the time of discharge,the NRS-2002 scores of patients in the intervention group were lower than those of the control group,with statistically significant differences(P<0.05).(2)At 7 days and 14 days of intervention,the patients in the intervention group had higher albumin,total protein and hemoglobin levels than the control group,with statistically significant differences(P<0.05).Repeated measures ANOVA results showed that the within-group,between-group and interaction effects for albumin,total protein and hemoglobin levels were statistically significant(P<0.05)for patients in the intervention and control groups at different time points.5.Comparison of neurological function and activities of daily living between the two groups of patients: the results of intra group comparison showed that at discharge,the NIHSS scores of patients in the intervention group and the control group were lower than those at admission,and the Barthel Index scores of patients in the intervention group and the control group were higher than those at admission,with a statistically significant difference(P<0.05).The results of inter group comparison showed that at the time of discharge,the NIHSS score of patients in the intervention group was lower than that in the control group,and the Barthel index score of patients in the intervention group was higher than that in the control group,with a statistically significant difference(P<0.05).6.Comparison of the incidence of secondary complications during hospitalization between the two groups of patients: in terms of constipation,gastric retention and lung infection,the incidence of patients in the intervention group was significantly lower than that in the control group,with a statistically significant difference(P<0.05),but the difference in the incidence of vomiting was not statistically significant(P>0.05).7.Comparison of hospitalization time and hospitalization costs between the two groups: the hospitalization time of the intervention group was shorter than that of the control group,and the difference was statistically significant(P<0.05);There was no significant difference in hospitalization cost between the intervention group and the control group(P>0.05).Conclusion:The nurse-led MDT mode intervention program reduces the incidence and severity of diarrhea in stroke patients with enteral nutrition via nasogastric tube,improves the nutritional status of patients,and further improves the neurological function and daily living ability of patients.It reduces the incidence of secondary complications and hospitalization time of patients,and has a certain impact on the hospitalization costs of patients,and promotes the clinical application and promotion of the nurse-led MDT mode. |
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