| Objectives: TO investigate the influence of individual nutritious intervention on nutritious improvement and the clinical outcome.of diabetics with severe trauma.Methods:1 The trauma patients,hospitalized between January 2015 and December 2015,were selected from four wards in the orthopaedics trauma emergency center of Third hospital,Hebei medical university.They were given AIS-90 trauma score,NRS2002 nutritional risk screening,SGA nutritional assessment.40 diabetic patients with their trauma scores 16~25 and NRS2002≧3 were chosen as research objects,and they were randomly divided into the experimental group and the control group.2 The Operations of both groups are scheduled at 8:00 on the surgery date.The control group patients received visits from the doctors of clinical nutrition department on the second day after hospitalization,and routine health education as well as nutritional lecturing before and after the surgery.The patients and their relatives were told about how to choose food which was arranged by the relatives themselves.No individual nutrition intervention was given.Water and food was forbidden since 0:00 on the surgery date,and conventional nursing methods were applied during the surgery.The experimental patients were visited by the doctors of clinical nutrition department on the second day after their hospitalization.The clinicians and the nutritionists worked out individual nutrition programs for them after discussion.They received uniformed nutritious food under the programs made and distributed by the canteen,and were supervised and guided by the primary nurses when eating.Food and water were forbidden at 0:00 on the surgery date in the experimental group.Glucose-insulin-polarized solution of Ka was given through intravenous drip at 6:00 in the morning(follow the physician’s orders),and individual nutritious supporting and nursing were given during the surgery according to the blood glucose level and the operating procedures.3 The questionnaire includes: general condition of the patients;whether the patients felt thirsty or their level of thirst from when the food and water was prohibited to when the surgery was finished;whether they felt hungry and their level of hunger;the daily frequency of hypoglycemia from the beginning of nutritional instruction to the 14 th day after the surgery.The infection and complications were recorded,mainly including catheter-related infection,wound infection,urinary system infection,pulmonary infection and those of no major signs but the temperature of the patient dropped to normal then rose to 38.5 ℃accompanied by an increase in leukocyte.Pressure sore includes sores of Ⅰ、Ⅱ、Ⅲ、Ⅳ stages,suspected deep soft tissue injury and sores of uncertain stages.The patients’ satisfaction of the medical and nursing services from the beginning of hospitalization to the 14 th day after surgery.4 Laboratory inspection:After hospitalization,both group patients were drawn peripheral venous blood on empty stomach,and their HbAlc,ALB,Hb,PA were all detected before nutritional instruction.Their blood glucose at 5:00 each day was also supervised before the instruction.Peripheral venous blood on empty stomach of the research objects was collected in the morning of the 1st,7th,14 th day after the surgery to detect their ALB,Hb,PA after the instruction,and their fasting blood glucose and the blood glucose 2 hours after meal was supervised on the 1st,3rd,7th day after the surgery.5 Clinical observation indicators: the occurrence of diabetes,the number of patients with hypoglycemia,the occurrence of infection and complications,wound healing level,and the patients’ satisfaction.Results:1 The differences of fasting blood glucose between the two groups were statistically significant,and the differences on different time were of statistical significance.An interaction was found in comparison between both groups and between different timings.Blood glucose over-time changing was different in two groups.The over-time reduction in the experimental group was bigger than that in the control.With further analysis on the simple effect,the difference on the 7th day after surgery was statistically significant,and differences on other time were of no statistic significance;the difference between the 1st and the 3rd day after surgery in the experimental group was not statistically significant.The difference between the 7th day and the 3rd day or between the 7th day and the 1st day after surgery was of no statistical significance.The difference between different timings in the control group was not statistically significant.2 In the comparison of blood glucose between the two groups 2 hours after meal,the difference was statistically significant,the difference between different timings was statistically significant.An interaction was found in the comparison between groups and different timings.The over-time changing of the patients’ blood glucose 2 hours after meal was different,and the over-time reduction of the experimental group was bigger than the control group.With further analysis of simple effect,in comparison between groups,the difference on the 3rd and the 7th day after surgery was of statistic significance.Difference on the other time were of no statistical significance.When comparing between different timings,the difference between the 3rd day and the 1st day after surgery was not statistically significant;the difference between the 7th day and the 3rd day or between the 7th day and the 1st day was statistically significant;the difference between different timings in the control group was of no statistic significance.3 In the comparison of ALB between both group patients after surgery,the difference between different groups and between different timings was of no statistic significance.4 In the comparison of PA between both group patients,the difference between groups are statistically significant;the difference between different timings was statistically significant.An interaction was found in the comparison between groups and between different timings.The over-time changing of PA in the two group patients after surgery was different,and the over-time increase of the experimental group was bigger than that of the control.With further analysis of the simple effect,in comparison between groups,the difference on the 1st day was of no statistical significance;the difference on the 7th day and on the 14 th day after surgery was of statistical significance.In the comparison between different timings,the difference between the 7th day and the 1st day was not statistically significant.The PA significantly increase on the 14 th day than on the 1st and 7th day after surgery,and the difference was of statistic significance.In the control group,the difference between the 7th day and the 1st day after surgery was not statistically significant;the PA significantly increased on the 14 day than on the 1st and the 7th day after surgery,and the difference was of statistical significance.5 In the comparison of Hb in both group patients after surgery,the difference between groups was of statistic significance;the difference between different timings was statistically significant.An interaction was found in the comparison between groups and between different timings.The over-time changing of Hb in both group patients was different,and the over-time increase of the experimental group was bigger than that of the control.With further analysis of the simple effect,in the comparison between groups,the difference on the 1st day and the 7th day was not statistically significant;the difference on the 14 th day after surgery was statistically significant.In the comparison of different timings,the difference between the 7th day and the 1st day after surgery in the experimental group was not statistically significant;the Hb increased significantly on the 14 th day than on the 1st and the 7th day,and the difference was statistically significant.In the control group,the difference between the 7th day and the 1st day after surgery was no statistically significant;the Hb increased significantly on the 14 th day than on the 1st day and the 7th day after surgery,and the difference was statistically significant.6 The level of patients’ thirst and hunger before surgery in the experimental group was significantly lower than that in the control group(P<0.05),and the difference in the number of patients with hypoglycemia between the two groups was statistically significant(P<0.05).7 In the experimental group,induration on the wound was found in only one case,and the other wounds all healed at the first grade without any infection.While in the control group,3 wounds were found with redness and swelling,2 with festering.The difference was statistically significant(P<0.05)(Fig.7).No infection was found in the experimental group,while in the control group,2 wounds were found with infection,1 with urinary system infection,1 with pulmonary infection,and the difference was statistically significant(P<0.05).8 Patients’ satisfaction of the experimental group was better than that of the control group(P<0.05).Conclusions:1 In treating diabetics with severe trauma,compared with the conventional model,individual nutritious intervention before,during and after the surgery can more effectively control blood glucose fluctuations,improve nutritional status,promote wound healing and reduce infection.2 In individual nutritious intervention,intravenous drip of glucoseinsulin-polarized solution of Ka for diabetics with severe trauma while water and food were forbidden can relieve thirsty and hungry,reduce episodes hypoglycemia and increase the patients’ satisfaction. |
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