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경정영양과 중심정맥영양을 공급받는 환자에서 질병의 상태(APACHEIII Score), 과대사 정도가 영양상태 및 임상적 결과에 미치는 영향
라미용,김은미,조영연,서정민,최혜미,Rha Mi yong,Kim Eun mi,Cho Young Y.,Seo Jeong Meen,Choi Hay mie 대한지역사회영양학회 2006 대한지역사회영양학회지 Vol.11 No.1
The aim of this study is to evaluate the clinical outcome. Between January 1,2002 to September 30, 2002, we prospectively and retrospectively recruited III hospitalized patients who received Enteral Nutrition (EN group n = 52) and Total Parenteral Nutrition (TPNgroup n = 59) for more than seven days. The factors of clinical outcomes are costs, incidences of infection, lengths of hospital stay, and changes in weight. The characteristics of patients were investigated, which included nutritional status, disease severity CAP ACHE III score) and hypermetabolic severity Chypermetabolic score). Hypermeta-bolic scores were determined by high fever (> $38^{\circ}C$), rapid breathing (> 30 breaths/min) , rapid pulse rate (> 100 beats/min), leukocytosis (WBC > 12000 $mm^{3}$), leukocytopenia (WBC > 3000 $mm^{3}$), status of infection, inflammatory bowel disease, surgery and trauma. There was a positive correlation between hypermetabolic score and length of hospital stay (ICU), medical cost, weight loss, antibiotics adjusted by age while APACHEIII score did not show correlation to clinical outcome. Medical cost was higher by $18.2\%$ in the TPN group than the EN group. In conclusion, there was a strong negative correlation between the clinical outcome (cost, incidence of infection, hospital stay) and hypermetabolic score. Higher metabolic stress caused more malnutrition and complications. For nutritional management of patients with malnutrition, multiple factors, including nutritional assessment, and evaluation of hypermetabolic severity are needed to provide nutritional support for critically ill patients.
국내 상급종합병원과 전국 분포 종합병원의 임상영양서비스 실태 조사 연구: 전국 규모 설문조사를 통하여
엄미향 ( Mi Hyang Um ),박유경 ( Yoo Kyung Park ),이송미 ( Song Mi Lee ),이승민 ( Seung Min Lee ),이은 ( Eun Lee ),차진아 ( Jin A Cha ),박미선 ( Mi Sun Park ),이호선 ( Ho Sun Lee ),라미용 ( Mi Yong Rha ),류은순 ( Eun Soon Lyu ) 대한영양사협회 2014 대한영양사협회 학술지 Vol.20 No.3
The purpose of this study was to investigate the status of clinical nutrition services provided at tertiary hospitals and general hospitals in Korea. In total, 157 questionnaires were distributed to the departments of nutrition at hospitals on September 2013. The results of this study are as follows. The median number of beds was 607 and average length of stay was 8 days. 63.1% of dietitians had over 5 years of career experience. Nutritional screening rate was 97% in tertiary hospitals but only 67.2% in general hospitals (P¼ 0.001). The rate of equipment with computerized nutritional screening system was 100% in tertiary hospitals but 71.9% in general hospitals (P¼0.001). Hospitals with the best regarding nutritional care were hospitals accredited by JCI (Joint Commission International). On the other hand, hospitals not accredited by the JCI but KOIHA (Korea Institute for Healthcare Accreditation) showed the lowest performance rate of nutritional care. Nutrition support teams (NSTs) were established in all tertiary hospitals but in only 73% of general hospitals (P¼0.001). The rate of actively operating NSTs was 89% in tertiary hospitals but only 62% in general hospitals (P¼0.001). There is a need to provide proper standardized clinical nutrition services as a primary treatment and we observed large variations in the quality of nutritional service between hospitals. Therefore, local solutions are needed to implement nutritional programs and policies for improved service and care.
병원 유형 및 지역에 따른 임상영양서비스에 대한 간호사의 인식
이한나 ( Han Na Lee ),이송미 ( Song Mi Lee ),박유경 ( Yoo Kyung Park ),이승민 ( Seung Min Lee ),이은 ( Eun Lee ),차진아 ( Jin A Cha ),박미선 ( Mi Sun Park ),이호선 ( Ho Sun Lee ),라미용 ( Mi Yong Rha ),류은순 ( Eun Soon Lyu ) 대한영양사협회 2014 대한영양사협회 학술지 Vol.20 No.4
The purpose of this study was to evaluate nurses` perception of clinical nutrition services. A cross-sectional survey design was performed. The research was accomplished by using questionnaires developed for this study and administered from September 12 to December 31, 2013 to 343 nurses at 43 tertiary hospitals and 20general hospitals. The percentage of nurses who recognized clinical nutrition certificate as issued from nation was 27.8%. The mean scores of perceived usefulness on clinical nutrition services was 4.23/5.00, whereas that of perceived implementation was 3.76/5.00. The mean scores of necessity of disease-specialized clinical dietitian at capital hospitals were significantly higher for obesity (P<0.01), cancer (P<0.05), and infant & childhood disease (P<0.01) than at local hospitals. The rates of nurses` experience in group education on cancerat capital hospitals (21.7%) was significantly higher than that at local hospitals (10.3%) (P<0.05). The means cores of perceived importance of clinical nutrition services were 4.46/5.00 for ‘group nutrition education’, 4.46/5.00 for ‘individual consultation’, and 4.40/5.00 for ‘nutrition management for enteral nutrition (EN) patients’. The most common reason why clinical nutrition services are important was ‘improving mal nutritional status’. To activate clinical nutrition services especially at local hospitals, clinical dietitians should give systematic assistance to patients and also institutional supports are needed.
체외막형 산화기를 시행한 심장내과 중환자실 입원 환자의 경장영양 지원: 관찰 연구
김성혜 ( Sung Hye Kim ),신윤진 ( Yoonjin Shin ),라미용 ( Mi Yong Rha ),조영연 ( Young Yun Cho ),양정훈 ( Jeong Hoon Yang ),조양현 ( Yang-hyun Cho ),서지영 ( Ji Young Seo ),강보리 ( Bori Kang ),김양하 ( Yangha Kim ) 한국정맥경장영양학회 2016 한국정맥경장영양학회지 Vol.8 No.3
Purpose: Enteral feeding remains controversial in patients receiving extracorporeal membrane oxygenation (ECMO), particularly in those treated with a high-dose vasopressor. This study examined the safety and feasibility of enteral nutritional support for patients undergoing ECMO in a cardiac care unit (CCU). Methods: Adult patients admitted to the CCU undergoing ECMO from January 2014 to May 2015 were included. Patients with <48 hours of support, undergoing ECMO at another hospital, and inaccurate medical records were excluded. Results: Among the 14 patients undergoing ECMO in the CCU, 2 patients were diagnosed with malnutrition and the others were in the normal state in the initial assessment. On the other hand, they had the malnutrition risk factors (anorexia, weight loss, fluid retention, and hypermetabolic state). Thirteen patients received enteral nutrition and 1 patient had possible oral intake. The average initiation day of enteral nutrition was 2.0±1.6 days on ECMO. The mean duration of enteral nutrition was 5.2±4.9 days and the target goal was achieved within 3 days. There were no serious adverse effects for enteral nutrition but 3 patients had gastrointestinal problems (diarrhea and anorexia), and gastrointestinal bleeding occurred in 1 patient. In 1 case, enteral nutrition had to be stopped due to the prone position. Overall, 5 patients were cured, 3 patients recovered through heart transplantation, and 6 patients died. Conclusion: Most CCU patients receiving ECMO were well nourished but had the malnutrition risk factors in progress. These results suggest that enteral feeding might be safe and feasible in patients treated with ECMO but there were minor side effects.
중환자의 초기 경장영양 공급 시 위잔여량에 따른 임상적 특징 분석
유소영 ( So Young Yu ),김은미 ( Eun Mee Kim ),조영연 ( Young Y Cho ),라미용 ( Mi Yong Rha ),김진용 ( Jin Young Kim ),장동경 ( Dong Kyung Chang ),서정민 ( Jeong Meen Seo ) 한국정맥경장영양학회 2010 한국정맥경장영양학회지 Vol.3 No.1
Purpose: A high gastric residual volume (GRV) occurs early and frequently in patients who are receiving nasogastric tube feeding in the intensive care unit (ICU). This study analyzed the clinical and nutritional characteristics of ICU patients who received nasogastric tube feeding according to the GRV. Methods: The subjects were 76 patients who were admitted to the ICU at S Medical Center from January, 2009 to May, 2009 and who received enteral nutrition (EN)support. Tube feeding was skipped when the GRV was over 50~100 cc. The patients who experienced meal skipping due to high GRVs comprised the GRV group, and the patients whose feeding was never skipped due to high GRVs comprised the non-GRV group. The general, clinical and nutritional characteristics were determined at the beginning of the EN support, and the method of EN was collected for the first 3 days of tube feeding. Results: Nine patients experienced meal skipping due to GRV. There were no significant differences between the GRV and NGRV group in terms of age (60.4 vs. 61.8 years for GRV and NGRV, respectively; same respective order hereafter), pre-npo (5.0 vs. 4.7 days) and the ICU stay (20.5vs. 23.7 days). Significant differences were evident in the GRV group concerning the ratio of male patients (55.2%vs. 88.9%; P<0.05), the medical-ICU patients (35.8% vs.88.9%; P<0.05) and the sedated patients (29.8% vs.66.7%; P<0.05). The BMI (22.4 vs. 21.8 kg/m2) and TLC(2,252 vs. 1,137 cells/mm3) values were not significantly different between the two groups. The serum albumin level(3.1 vs. 2.6 g/dl) was significantly lower in the GRV group(P<0.05) and the C-reactive protein level (8.11 vs. 19.02mg/dl) and the ratio of moderately and severely malnourished patients (25.4% and 77.8%) was significantly higher in the GRV group (P<0.05). The mean feeding volume (731vs. 688 cc) and ratio of the feeding rate (129 vs. 127 ml/h)during the first 3 days on EN was not significantly different between the two groups, nor was the required/maximum feeding volume (9.8 vs. 8.2 days).Conclusion: In the GRV group, the ratio of male to sedated patients was significantly higher than that in the other group. The ratio of moderately and severely malnourished patients was also significantly higher in the GRV group. There were no significant differences in the methods of EN support. (KJPEN 2010;3(1):50-53)