| Objective:The purpose of the research is to understand the clinical detection rate of the disease and related influencing factors through screening patients with liver cirrhosis for Minimal hepatic encephalopathy,combining the indicators related to nursing in the influencing factors of the disease,and take evidence-based guidance to construct Minimal hepatic encephalopathy nutritional management program for patients with encephalopathy.The research aims at providing a set of feasible programs for the targeted intervention measures for the target population in the future clinical work,and improving the patient’s disease symptoms and quality of life.Methods:1.Select 153 patients with liver cirrhosis who were hospitalized in the infectious disease department of a tertiary A general hospital from July 2019 to September 2020 and met the admission criteria.Use the Number Connection Test-A(NCT-A),the Number Sign Test(DST)and the Simplified Animal Naming Test(S-ANT1)in the Neuropsychological Test(PHSE)to check patients for Minimal hepatic encephalopathy.Among the three tests,the patients with abnormal items ≥ 2 were diagnosed as Minimal hepatic encephalopathy.Understand the incidence of Minimal hepatic encephalopathy in patients with liver cirrhosis,and divide the included patients into Minimal hepatic encephalopathy group and non-Minimal hepatic encephalopathy group by analyzing the screening results.(Compare the general information(gender,age,Ethnicity,education,medical history,etc),imaging data(CT,color Doppler ultrasound,etc),laboratory test results(blood routine,liver function,renal function,coagulation function,blood lipids,etc)of two groups of patients to analyze Minimal hepatic encephalopathy Related influencing factors of patients with liver cirrhosis.Use the Chronic Liver Disease Quality of Life Questionnaire(CLDQ)and the Royal Free Hospital Nutrition Priority Tool(RFH-NPT)to evaluate the patients’ recent quality of life and nutritional risk individually,and obtain the patients’ hospital stay,hospital expenses,and non-planned re-hospitalization within 30 days after leaving hospital.The collected information will be used to evaluate and analyze the overall quality of life of patients with liver cirrhosis and Minimal hepatic encephalopathy.The data was analyzed using SPSS18.0 and Graph Pad Prism 8.4.0 statistical software.2.Browse Pub Med,EMbase,Web of science,Cochrane Library,How Net,Wanfang and other domestic databases and guideline development websites,and use the combination of subject terms and free words to search for Minimal hepatic encephalopathy nutrition Management related evidence during 2010 to 2020.According to the results of the literature quality assessment,the relevant indicators that will eventually be included in the literature are summarized in evidence,and a preliminary nutrition management plan is drawn up.Invite experts in related fields to conduct a letter consultation with Delphi experts on the plan,and determine the final nutritional management plan for patients with liver cirrhosis and Minimal hepatic encephalopathy based on the results and opinions of the letter.Results:1.Detection of Minimal hepatic encephalopathy:A total of 153 hospitalized patients with liver cirrhosis were screened after signing informed consent.122 patients among the group were with viral hepatitis and liver cirrhosis,7 were with alcoholic liver cirrhosis,16 were with cirrhosis caused by two or more pathogenies,and 8 were caused by other pathogenies.After the screening,87 patients were diagnosed with liver cirrhosis combined with Minimal hepatic encephalopathy.The detection rate was 56.86%.Among the positive patients,compensated cirrhosis patients accounted for 9.19%(8/87),and decompensated patients accounted for90.81%(79/87).2.Analysis results of influencing factors:2.1 Comparison of general data The comparison of general data between two groups of patients with the spec of gender,age,education,ethnicity,etiology,and BMI(body index)shows no significant difference(P>0.05).In terms of severity of illness,history of drinking,history of HE,and persistent PPI,There are differences in the use of ascites and related complications(hypoproteinemia,spontaneous peritonitis,infection),etc.Statistical significance(P<0.05).2.2 Comparison of laboratory-related data The comparison of laboratory-related data between the 2 groups of patients with the spec of Child-Pugh classification,uric acid,serum sodium,total bilirubin,Pre-protein,serum albumin,fasting blood glucose,international standard ratio,platelets,total cholesterol,total protein,etc.shows statistically significant difference(P<0.05).Among 87 patients diagnosed with Minimal liver disease,Child A,B,C grades were 2.29%(2/87),54.02%(47/87),and 43.69%(38/87),The difference between Child A+B grade and Child C grade was statistically significant(P<0.05).2.3 Comparison of quality of life The differences between the two groups of patients in the chronic liver disease quality of life score(CLDQ),length of hospitalization,hospitalization expenses,and unplanned readmissions within 30 days after leaving hospital were statistically significant(P<0.05).2.4 Comparison of nutritional status The difference in nutritional risk levels between the two groups of patients was statistically significant(P<0.05).Among patients with Minimal hepatic encephalopathy,29.89%(26/87)of patients with low/medium nutritional risk and70.11%(68/87)of the patients with high nutritional risk,the difference was statistically significant(P<0.05).2.5 Independent influencing factors of disease 10 years of drinking history,severity of illness,ascites,platelets,serum sodium,international standard ratio,infection,chronic liver disease quality of life score(CLDQ)in the activity dimension and Child C level are the main influence factors for patients with liver cirrhosis complicated by Minimal hepatic encephalopathy.Total bilirubin(OR=1.027,P<0.01)and high nutritional risk(OR=3.450,P<0.05)are independent risk factors for the disease,and albumin(OR=0.849,P<0.01)),the degree of fatigue in the chronic liver disease quality of life score(CLDQ)(OR=0.803,P<0.01)are independent protective factors for the disease.3.Through evidence-based domestic and foreign related research,a total of 17 documents were included,including 4 expert consensus and 6 international guidelines.There were 2systematic reviews,4 RCTs,and 1 cohort study.53 recommendations were preliminarily summarized.4.The activeness of the two rounds of expert letter inquiries were 88.89% and 100%individually,and the rate of opinions raised was 43.75% and 35.25%.The authority coefficient is 0.896;the harmony coefficients of the two rounds of expert consultation are0.559 and 0.648 respectively,and the chi-square test shows P<0.01.The final plan includes nutrition management team construction,nutrient management,nutritional approach,fluid management,diet frequency management,energy intake management,and social-psychological management with 51 recommendations in 7 dimensions.Conclusion:1.Among patients with liver cirrhosis,the detection rate of Minimal hepatic encephalopathy is higher,and the quality of life is poorer.In clinical work,the screening of the target population should be strengthened,and early intervention should be carried out to promote the outcome of the disease.2.Minimal hepatic encephalopathy occurs under the synergistic effect of multiple factors with liver function damage and nutritional deficiency as the core.In clinical work,the monitoring of patients’ liver function,nutritional risk,quality of life and other related indicators should be strengthened.3.The nutrition management plan for patients with liver cirrhosis and Minimal hepatic encephalopathy constructed by this research is based on clinical research and evidence-based nursing,and has been revised by domestic nutrition,nursing,and clinical multidisciplinary experts.It has scientific,manipulable,and Clinical application value. |
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