Clinical Effect of Comprehensive Intervention of Structural Nutrition on Perioperative Cochlear Implant Patients
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摘要:
目的 了解围手术期结构性营养综合干预对人工耳蜗植入患者并发症、医疗费用、满意度等影响，为探索人工耳蜗植入患者管理模式提供参考依据。 方法 2018年1月1日至2020年11月30日期间，采用自制问卷对纳入研究对象进行调查，干预组采用结构性营养综合干预模式，对照组采用传统的常规模式。收集不同管理模式下患者听觉行为分级、言语可懂度分级、并发症、医疗费用以及满意度等信息。 结果 干预组与对照组听觉行为（P = 0.085）以及组别和时间的交互效应（P = 0.075）差异不具有统计学意义；干预组与对照组言语可懂分级（P = 0.072）以及组别和时间的交互效应（P = 0.066）差异不具有统计学意义，而干预组与对照组听觉行为（P = 0.045）、言语可懂分级（P = 0.039）在时间段上差异具有统计学意义，干预组与对照组并发症（χ2 = 4.406，P = 0.036）、医疗费用（t = -17.131，P < 0.001）、满意度得分（t = 3.489，P = 0.007）差异具有统计学意义，多因素分析，营养综合干预、体重指数增加、满意度提高患者术后并发症发生机会越小。 结论 结构性营养综合干预可以有效改善人工耳蜗植入患者临床结局，降低患者的医疗费用，提升患者家属满意度，在人工耳蜗植入患者中有必要推行结构性营养综合干预管理模式。 Abstract:Objective To understand the influence of perioperative comprehensive structural nutrition intervention for cochlear implant patients on the complications, medical costs and satisfaction of cochlear implant patients, so as to provide reference for exploring the management mode of cochlear implant patients. Methods Self-assessment questionnaires were used to investigate the subjects from January1 2018 to November 30 2020. The comprehensive structural nutrition intervention mode was used in the intervention group, and the traditional conventional mode was used in the control group. The information such as auditory behavior classification, speech intelligibility classification, complications, medical expenses and satisfaction degree of the patients under the unmanaged mode from January 1 2018 to November 30 2020. Results The difference between the intervention group and the control group was not statistically significant in the auditory behavior grading and speech intelligibility grading at admission, 3 months and 6 months after operation （P > 0.05）. There was statistically significant differences in the complications （χ2 = 4.406, P = 0.036）, medical expenses （t = -17.131, P < 0.001）, satisfaction score （t = 3.489, P = 0.007） between the intervention group and the control group. The multivariate analysis showed that patients with comprehensive nutrition intervention, increased body mass index, and improved satisfaction were less likely to have postoperative complications. Conclusions Comprehensive intervention of structural nutrition can effectively improve the clinical outcome of cochlear implant patients, reduce medical costs of the patients, and improve the satisfaction on the patients family members. Therefore, it is necessary to implement the comprehensive intervention management model of structural nutrition in cochlear implant patients. -
Key words:
- Perioperation /
- Nutrition /
- Cochlear implants /
- Clinical effect
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表 1 干预组与对照组人口学特征差异性比较（n）
Table 1. Comparison of demographic characteristics between intervention group and control group （n）
项目 干预组 对照组 Z/χ2 P 性别 男 29 31 0.01 0.978 女 25 27 年龄（岁） < 4 26 28 −0.013 0.990 4～8 18 19 > 8 10 11 父母最高文化 中专及以上 35 36 −0.308 0.758 高中 14 16 初中及以下 5 6 经济收入（元） < 2 000 17 20 −0.095 0.925 2 000～4 000 27 26 > 4 000 10 12 BMI（kg/m2） < 18.5 15 16 −0.058 0.953 18.5～23.9 30 32 ≥24 9 10 NRS < 3 34 39 0.226 0.635 ≥3 20 19 
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表 2 干预组与对照组者听觉行为差异性比较（
$\bar x \pm s$ ）Table 2. Comparison of auditory performance difference between intervention group and control group （
$\bar x \pm s$ ）分组 n 入院时 术后3月 术后6月 因素 Wilks’ lambda F P 干预组 54 1.01 ± 0.59 1.69 ± 0.82 2.68 ± 0.93 组别 1.212 3.92 0.085 对照组 58 1.04 ± 0.61 1.64 ± 0.77 2.59 ± 0.92 时间 0.478 4.74 0.045 组别*时间 0.654 2.98 0.075
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表 3 干预组与对照组患者言语可懂度分级差异性比较（
$\bar x \pm s $ ）Table 3. Comparison of the speech intelligibility rating difference between intervention group and control group （
$\bar x \pm s $ ）分组 n 入院时 术后3月 术后6月 因素 Wilks’ lambda F P 干预组 54 1.23 ± 0.45 2.31 ± 0.52 2.81 ± 0.70 组别 1.574 4.35 0.072 对照组 58 1.22 ± 0.43 2.28 ± 0.49 2.80 ± 0.69 时间 0.513 3.24 0.039 组别*时间 0.862 3.17 0.066
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表 4 干预组与对照组患者并发症发生情况差异性比较[n（%）]
Table 4. The complications analysis on sexual function of Olson of male patients after Miles in laparoscopic operatiodifference intervention group and control group [n（%）]
分组 n 无并发症 有并发症 χ2 P 干预组 54 52（96.3） 2（3.7） 4.406 0.036* 对照组 58 49（84.5） 9（15.5） *P < 0.05。
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表 5 干预组与对照组医疗费用与患者家属满意度差异性比较（
$\bar x \pm s$ ）Table 5. Comparison of the medical expenses and patient family satisfaction difference between intervention group and control group （
$\bar x \pm s$ ）分组 n 医疗费用（元） 满意度得分（分） 干预组 54 15216.5 ± 243.7 84.7 ± 9.8 对照组 58 15998.8 ± 239.4 78.6 ± 8.7 t −17.1319 3.489 P < 0.001* 0.007* *P < 0.05。
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表 6 人工耳蜗植入患者术后并发症的影响因素分析赋值表
Table 6. Variable assignment on multiple linear regression of factors influencing complications after cochlear implant patients
因素 变量 赋值说明 年龄（岁） X1 < 4 = 1 4-8 = 2 ≥8 = 3 性别 X2 男 = 1 女 = 2 文化水平 X3 初中及以下 = 1 高中 = 2 中专及以上 = 3 经济收入 X4 ≤2 000 = 1 2000～4000 = 2 ≥4000 = 3 BMI X5 得分 NRS X6 < 3 = 1 ≥3 = 2 CAP X7 得分 SIR X8 得分 满意度 X9 得分 是否采用干预模式 X10 是 = 1 否 = 0 并发症 y 无 = 0 有 = 1
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表 7 人工耳蜗植入患者术后并发症的影响因素分析的结果
Table 7. The result of multiple linear regression analysis of complications after cochlear implant patients
影响因素 B S.E Wald Sig. Exp（B） 95.0%C.L.for EXP（B） Lower Upper 体重指数 −1.201 0.647 3.440 0.064 1.322 0.934 11.81 满意度 −1.168 0.376 9.668 0.002 2.217 61.540 86.72 是否采用营养综合干预 −1.886 0.376 8.536 0.003 6.592 1.860 23.356 常数项 5.059 1.510 11.230 0.001 0.006
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[1] Kaplan D M,Puterman M. Pediatric cochlear implants in prelingual deafness:medium and long-term outcomes[J]. Isr Med Assoc J,2010,12(2):107-109. [2] 金伟,宁丽丽,刘燕京,等. 人工耳蜗植入围手术期的心理护理探讨[J]. 中华耳科学杂志,2013,11(1):118-120. [3] Marlowe A L,Chinnici J E,Rivas A,et al. Revision cochlear implant surgery in children:the Johns Hopkins experience.[J]. Otology & Neurotology,2010,31(1):74-82. [4] Hendry P O,Hausel J,Nygren J,et al. Determinants of outcome after colorectal resection within an enhanced recovery programme.[J]. British Journal of Surgery,2009,96(2):197-205. doi: 10.1002/bjs.6445 [5] Drescher T,Singler K,Ulrich A,et al. Comparison of two malnutrition risk screening methods(MNA and NRS 2002)and their association with markers of protein malnutrition in geriatric hospitalized patients[J]. Eur J Clin Nutr,2010,64(8):887-893. doi: 10.1038/ejcn.2010.64 [6] Schwegler I,von Holzen A,Gutzwiller J P,et al. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer.[J]. British Journal of Surgery,2010,97(1):92-97. [7] 刘勇智. 低龄幼儿人工耳蜗植入后听觉能力发展的初步分析[J]. 内蒙古医学杂志,2010,42(4):429-431. doi: 10.3969/j.issn.1004-0951.2010.04.018 [8] 叶惠莲,赖爱如,李小志. 家庭语训在小儿人工耳蜗植入术后中的应用[J]. 齐鲁护理杂志,2013,19(20):40-41. doi: 10.3969/j.issn.1006-7256.2013.20.019 [9] 何润莲,沙凤,梁艳平,等. MNA-SF、NRS 2002、GNRI在老年住院患者营养筛查中的应用[J]. 昆明医科大学学报,2019,40(09):18-22. [10] 贾欢,陈颖,张治华,等. 人工听觉脑干植入在先天性耳聋低龄儿童中的应用探索[J]. 上海交通大学学报(医学版),2020,40(10):1324-1329. doi: 10.3969/j.issn.1674-8115.2020.10.004 [11] 郭思荃,李华伟,陈兵,等. 语后聋患者人工耳蜗植入后听觉行为及言语可懂度分级的相关因素分析[J]. 临床耳鼻咽喉头颈外科杂志,2014,28(13):955-957+960. [12] Di Lella F,Bacciu A,Falcioni M,et al. Long-term clinical outcomes of cochlear implantation in children with symptomatic epilepsy[J]. Int J Pediatr Otorhinolaryngol,2016,82(1):23-27. [13] Cortés Fuentes I A,Videhult Pierre P,Engmér Berglin C. Improving clinical outcomes in cochlear implantation using glucocorticoid therapy:a review.[J]. Ear Hear,2020,41(1):17-24. doi: 10.1097/AUD.0000000000000740 [14] Svirsky M A,Chin S B,Jester A. The effects of age at implantation on speech intelligibility in pediatric cochlear implant users:Clinical outcomes and sensitive periods[J]. Audiological Medicine,2007,5(4):293-306. doi: 10.1080/16513860701727847 [15] 杨鑫,崔红元,陈伟,等. 普通外科病人住院期间营养风险和营养不良动态变化的多中心横断面调查[J]. 肠外与肠内营养,2020,27(5):270-273+279. [16] 郭艳慧. 心脏手术患者围手术期口服营养补充与临床结局的关系[D]. 石家庄: 河北医科大学硕士论文, 2019. [17] 李响,李志远,廖中凯,等. 术前营养风险指数对心脏移植手术后患者结局的预测作用[J]. 中华胸心血管外科杂志,2019,35(1):49-51. doi: 10.3760/cma.j.issn.1001-4497.2019.01.012 [18] 卢艳萍. 住院患儿入院时的营养状况调查[D]. 福州: 福建医科大学硕士论文, 2017. [19] 平雅. 回顾性调查分析医院感染患者营养状况和营养支持效果[D]. 石家庄: 河北医科大学硕士论文, 2018. [20] 徐萍,邹卫珍. 舒适护理在低龄语前聋患儿人工耳蜗植入术中的应用[J]. 皖南医学院学报,2015,34(6):603-605. doi: 10.3969/j.issn.1002-0217.2015.06.028 [21] 董丽艳,张亚萍,尤莹莹,等. 加速康复外科护理在低龄人工耳蜗植入患儿围手术期的应用[J]. 实用临床护理学电子杂志,2020,5(11):67+92. -
