내과계 중환자실에서 영양집중지원 의뢰환자와 미의뢰환자 영양상태와 효과 비교

Abstract

This study aims to compare nutritional status and the biochemical numerical values of patients who requested intensive nutritional support and those who did not and the effects that nutritional support activity had on their nutritional status, The subjects of this study were patients hospitalized in an ICU at C hospital in Gwangju City. As a result, for subjects who requested intensive nutritional support, the odds ratio for those who were hospitalized for 8-14 days was 68.499 (95% CI: 2.333-201.269), that for those who were hospitalized for 15-21 days was 58.436 (95% CI: 1.420-240.362), that for those who were hospitalized for 22-28 days was 170.279 (95% CI: 3.842-754.133), and that for those who were hospitalized for more than 29 days was 678.617(95% CI: 15.072-3,055.900), significantly higher than those who were hospitalized for less than 8 days in the ICU. The greater the days of hospitalization, the greater the odds ratio was for requested intensive nutritional support. However, as for the odds ratio for requested intensive nutritional support, that for those who were hospitalized in the ICU for 8-14 days was 0.059 (95% CI: 0.013-0.264), and that for those who were hospitalized in the ICU for more than 15 days was 0.117 (95% CI: 0.025-0.538). The greater the days of hospitalization in the ICU, the significantly lower the odds ratio was for requested intensive nutritional support. As for the albumin concentration in the blood, by which doctors decided on the need for nutritional support, the odds ratio was 33.527 (95% CI: 8.516-131.986), or significantly high. The odds ratio for enteral nutrition was 0.188 (95% CI: 0.048-0.731), or significantly low in comparison with parenteral nutrition. The odds ratio for those who requested intensive nutritional support and had edema was 0.017 (95% CI: 0.001-0.273), or significantly lower than that for those who did not request it. As a result of analysing the effects of intensive nutritional support according to its request, with respect to changes in the calory supply volume for subjects according to the nutritional support routes, the calory feeding rate (%) of the subjects through nutrient therapy was 750.9±588.8 kcal at the beginning, 622.1±345.9 kcal after seven days, and 639.7±383.3 kcal after fourteen days, or significantly high. However, that for the subjects who did not request intensive nutritional support was 524.1±342.6 kcal at the beginning, 747.9±447.6 kcal after seven days and 842.1±438.6 kcal after fourteen days, which indicates that calory feeding through nutrient therapy increased. There was a significant difference in the time spacing between the two groups according to request (p=0.045). The nutrient supply rates of the requesting subjects through enteral feeding were 206.4±235.2 kcal at the beginning, 647.9±361.9 kcal after seven days, and 626.0±259.3 kcal after fourteen days. Those for non-requesting subjects were 345.4±200.8 kcal at the beginning, 500.8±274.6 kcal after seven days, and 702.8±351.8 kcal after fourteen days. There was a significant difference in the time of request(p=0.001), but there was no significant difference between the requesting or non-requesting groups. As a result of comparing the changes in the rates of nutrient supply, the rates for the requesting subjects was 50.3±33.9% at the beginning, 52.2±33.1% after seven days, and 55.8±29.1% after fourteen days. Those for non-requesting subjects were 55.5±30.4% at the beginning, 53.5±30.2% after seven days, and 58.9±29.9% after fourteen days. There was a significant difference in the time of request (p=0.011), but there was no difference between the requesting and non-requesting groups. The protein supply rates for the requesting subjects were 44.1±37.8% at the beginning, 45.3±24.2% after seven days, and 57.0±32.3% after fourteen days. Those for non-requesting subjects was 45.3±24.2% at the beginning, 51.1±24.9% after seven days, and 57.7±27.9% after fourteen days. There was a significant difference in time of request(p=0.028), but there was no significant difference between requesting and non-requesting. As a result of analysing the effects according to request of intensive nutritional support, the changes in electrolyte biochemical indexes were: The potassium concentration in the blood of the requesting subjects was 3.7±0.6 mEq/L at the beginning, 3.6±0.7 mEq/L after seven days, and 3.7±0.8 mEq/L after fourteen days. The potassium concentration in the blood of the non-requesting subjects was 4.6±0.9 mEq/L at the beginning, 3.8±0.6 mEq/L after seven days, and 4.1±0.6mEq/L after fourteen days. There was no significant difference in time of request, but there was a significant difference between requesting or non-requesting (p=0.001). The results of analysing the metabolic biochemical values were: Glucose concentration in the blood of the requesting subjects was 137.2±67.0 mg/dl at the beginning, 135.3±80.3 mg/dl after seven days and 127.1±56.3 mg/dl after fourteen days. The glucose concentration in the blood of the non-requesting subjects was 174.9±199.6 mg/dl at the beginning, 97.8±23.4 mg/dl after seven days and 93.5±21.3 mg/dl after fourteen days. There was a significant difference in time of request (p=0.026), but there was no significant difference between the requesting and non-requesting groups. The cholesterol concentration in the blood of the requesting subjects was 107.9±42.3 mg/dl at the beginning, 98.9±36.7 mg/dl after seven days, and 85.1±34.7 mg/dl after fourteen days. That for the non-requested subjects was 103.0±25.5 mg/dl at the beginning, 80.0±56.6 mg/dl after seven days, and 85.0±59.4 mg/dl after fourteen days. As time of request went, it became significantly lower(p=0.015), there was no significant difference in requesting and non-requesting. As for Triglyceride, there was no significant difference in time of request, there was a significant difference between requesting and non-requesting(p=0.049). As a result of analysing the biochemical values on liver function, the ALT concentration in the blood was 21.0±15.6 U/L at the beginning, 24.2±16.5 U/L after seven days, and 28.5±35.4 U/L after fourteen days. That for the non-requesting subjects was 24.3±15.8 U/L at the beginning, 24.3±19.4 U/L after seven days, and 35.1±21.4 U/L after fourteen days. There was a significant difference in the time of request and non-request(p=0.025), but there was no significant difference between the requesting and non-requesting groups. The AST concentration in the blood of the requesting subjects was 42.8±32.3 U/L at the beginning, 49.4±58.3 U/L after seven days, and 67.8±125.3 U/L after fourteen days. The AST concentration in the blood of the non-requesting subjects was 63.5±50.7 U/L at the beginning, 47.4±35.2 U/L after seven days, and 39.3±11.9 U/L after fourteen days. There was a significant difference in time for request and non-request(p=0.001). As for ALK, there was also a significant difference in the time of request and non-request(p=0.019). As a biochemical value, Hemoglobin in the blood of the requesting subjects was 9.8±3.1 g/dl at the beginning, 8.8±1.9 g/dl after seven days, and 8.7±1.5g/dl after fourteen days. That for the non-requesting subjects was 11.3±1.6 g/dl at the beginning, 10.9±4.6 g/dl after seven days and 8.6±2.1 g/dl after fourteen days. There was no significant difference in time for requesting and non-requesting, but there was a significant difference between requesting and non-requesting (p=0.048). In conclusion, according to intensive nutritional support, the nutrient supply rate through enteral feeding increased significantly and there was a significant difference in changes in biochemical values between the two groups. Therefore, to prevent delays in treatment and aggravation of symptoms due to malnutrition in patients hospitalized, this study suggests that educational programs on intensive nutritional support activity which facilitates understanding the need for a proper nutrient supply should be provided for all medical staff and systematic nutritional support by intensive nutritional support team should be given to patients in order to decrease the number of patients in the ICU or their days of hospitalization.