| Objective: Investigation in total parenteral nutrition infusion process, single bottle infusion caused a variety of adverse reactions, Observe the infusion way of parenteral nutrition preparation and infusion method of the impact on the postoperative clinical outcome, analysis of risk factors of nutrient solution infusion complications, it affects again seek the single infusion bottle milk fat and the malpractice of bottle infusion of amino acids. Methods: From October 2014 to December 2015,This study is a prospective randomized controlled study,Were selected Jinling Hospital, Henan Provincial People’s Hospital, Lanzhou Military Region General Hospital, Yangzhou Subei People’s Hospital, the hospital authorities in Jiangsu Province, the First Affiliated Hospital of Bengbu Medical College, Sichuan University West China Hospital general surgery, gastrointestinal surgery met the inclusion criteria hospitalized patients.Continuous sentinel convenience sampling method,Met the inclusion criteria of189 cases of All in one patients infusion parenteral nutrition patients and 194 cases a single bottle infusion parenteral nutrition patients included in this study.In patients admitted to hospital 24 hours, the use of NRS-2002 scale of nutritional risk screening(if NRS- 2002 score is greater than or equal to 3 into a nutritional risk),And in the next morning after admission and the way of the same continuous infusion in nutrient solution for 7 days morning test nutrition related indexes, hematology indexes, phlebitis,and other related complications, And record the gender, age, disease, nutrient solution configuration mode and kinds of nutrient, infusion method and approach of infusion, etc.All research projects using logistic regression analysis, first by single factor regression analysis on the unconditioned extract statistically significant risk factors, based on multiple factors regression analysis on the unconditioned again find out the independent risk factor for the formation of phlebitis patients, analyze the influence of the complications of nutrient solution infusion risk factors. Compare all-in-one with single bottle infusion group before infusion reaction similar between the two groups, the baseline data using rank homogeneity of testing and inspection, in addition to height was statistically significant(P < 0.05), other project had no statistical significance(P >0.05), two groups of comparable.Results:(1) The unconditioned logistic regression model of single factor analysis showed: age, height, nationality, white blood cells, platelets, blood glucose, Alt, total bilirubin, triglyceride, total protein, configuration method of nutrient fluids, infusion method of nutrient fluids, infusion of nutrient solution way, average infusion speed and nutrient infusion site has the significance of statistical analysis(P < 0.15).(2) The multi-factor unconditioned logistic regression analysis, the results show that the cultural degree, total protein, configuration method of nutrient fluids, infusion method of nutrient fluids, infusion way of nutrient fluids, infusion speed on average is a risk factor for phlebitis occurred was statistically significant; After standardization display(table 4),total protein [risk odds ratio(OR)=1.06,5% confidence interval(CI)=1.028-1.093, X2=14.013], Risk of nutrient solution configuration way [risk odds ratio(OR)=0.225, 95% confidence interval(CI)=0.100-0.509, X2 = 12.858], the nutrient solution infusion way [risk odds ratio(OR)= 0.209, 95% confidence interval(CI)=0.111-0.392, X2=23.770], nutrient solution infusion [risk odds ratio(OR)=1.834,95% confidence interval(CI)=1.304-2.578, X2=12.150], the average drop speed [risk odds ratio(OR)=0.864, 95% confidence interval(CI) =0.828-0.903, X2=43.066],nutrient infusion site risk odds ratio(OR)=1.132, 95% confidence interval(CI)=1.433-2.452, X2=13.534],The standardized regression coefficient standard p value is less than 0.0001, is the independent risk factor for the formation of phlebitis.(3) 383 cases of patients with total protein ≥ 68.3 g/L of the incidence of phlebitis(18.44%), lower than the total protein < 68.3 g/L of the incidence of phlebitis(37.25%),the significance of difference has a statistical analysis(P<0.05);Common ward configuration platform configuration of nutrient solution incidence of phlebitis(36.40%), higher than the unit nutrient solution purification machine configuration incidence of phlebitis(11.38%), the significance of difference has a statistical analysis(P<0.05); Channel infusion solution by mixing incidence of phlebitis(34.82%),higher than over a dedicated channel infusion solution of the incidence of phlebitis(16.91%); Through the infusion solution of venous indwelling needle, the incidence of phlebitis(31.53%), higher than by peripherauy inserted central catheter infusion solution of the incidence of phlebitis(22.22%), the significance of difference has a statistical analysis(P<0.05); Average infusion rate ≥ 52 drops/min the incidence of phlebitis(40.72), higher than the average infusion rate < 52 drops/min the incidence of phlebitis(16.76%),the significance of difference has a statistical analysis(P<0.05);Palm dorsal vein phlebitis incidence was 33.59%; basilic vein phlebitis incidence rate was 30.77%; median cubital vein phlebitis occurrence rate of 28.38%; cephalic vein phlebitis occurred rate was 35.00%; subclavian vein phlebitis occurred rate was 17.65%;jugular vein phlebitis occurred rate was 15.38%, The difference have no sense of statistics analysis(P>0.05).(4) 189 cases accepted total nutritional support of patients and 194 cases accepted single bottle transfusion note nutrition of patients. After 7 days of nutritional support treatment,the patient’s white blood cells, lymphocytes, platelet, blood glucose, glutamic pyruvic transaminase, total bilirubin, blood urea nitrogen, creatinine, glycerol ester, albumin,total protein, albumin weight, height difference has statistical significance(P < 0.05).And there was no significant difference in hemoglobin and total cholesterol(P > 0.05)(see Table 9).(5) The all-in-one nutritional support of patients, after 7 days of nutritional support treatment, the patient’s white blood cells, lymphocytes, urea nitrogen, triglyceride, total cholesterol, albumin, prealbumin is significantly higher than before treatment, patients with lower hemoglobin, total protein and weight, the difference was statistically significant(P<0.05). And platelet, blood glucose, Alt, total bilirubin, creatinine, height,compared with before treatment, there was no statistically significant difference(P>0.05)(6) Patients with single bottle infusion nutrition support, after 7 days after nutritional support treatment, patients’ lymphocytes, hemoglobin, ALT, total bilirubin, urea nitrogen, creatinine, triglyceride, total cholesterol, total protein, albumin significantly more nutritional treatment before the high, patients with platelet, weight decrease, the difference was statistically significant(P<0.05). And platelet, blood glucose, albumin,height, compared with before treatment, there was no statistically significant difference(P>0.05)(7)All-in-one group physiological comfort and total score higher than that of single bottle infusion group,the difference was statistically significant(P<0.05). And mental comfort,social culture comfort,environmental comfort,there was no statistically significant difference(P>0.05).(8) Patients with single bottle infusion nutrition preparation, the sleep quality,sleep time,sleep time,sleep disorder, sleep efficiency, sleep medication,daytime dysfunction, and total score were below the all-in-one nutrient solution infusion group,the difference was statistically significant(P < 0.05).And the hypnotic drug dimensions, there was no statistically significant difference(P>0.05)(9)Single bottle infusion set of phlebitis, incidence of local pain, local tissue edema were higher than all-in-one infusion group, the difference was statistically significant(P< 0.05), and fever, flustered, nausea and vomiting, are similar between the two groups has no statistical significance(P > 0.05)Conclusion:(1) The total protein and configuration method of nutrient fluids, infusion method of nutrient fluids, infusion of nutrient solution way, average drip speed,nutrient infusion site, is the independent risk factor for the formation of phlebitis.(2)Total protein ≥68.3 g/L,the incidence of phlebitis lower than the total protein <68.3 g/L the incidence of phlebitis; Department purification machine allocation nutrient solution can reduce the incidence of phlebitis; Through a dedicated channel infusion solution, than by mixing channel infusion solution low incidence of phlebitis. The way of peripherauy inserted central catheter infusion nutrient of phlebitis, below infusion in patients with venous indwelling needle; The average drip speed < 52drops/min, can reduce the incidence of phlebitis,the incidence of phlebitis was higher in the dorsal median vein and the head vein..(3)According to the results of this study in patients undergoing single bottle infusion nutrition preparation, serum creatinine, blood urea nitrogen increased significantly, and increase the load in patients with liver and kidneys.(4)All-in-one infusion in patients with comfort, higher than the single bottle infusion group.(5) The single bottle infusion in patients with sleep quality, sleep time, sleep time, sleep disorder, sleep efficiency and hypnotic drugs, daytime dysfunction, better than all-in-one infusion group.(6) This study found that single bottle infusion group phlebitis, local pain, incidence of local tissue edema, were higher than all-in-one infusion group. |
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