目的探讨奥马哈系统护理模式对营养不良慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者营养状况的干预效果。方法选取2016年6月—2017年6月就诊于南京大学医学院附属鼓楼医院的营养不良COPD患者60例,随机分为观察组和对照组各30例。对照组给予常规护理,观察组按奥马哈系统护理模式进行营养干预。采用微型营养评估量表(The Mini Nutritional Assessment,MNA)、慢性阻塞性肺疾病评估测试(COPD Assessment Test,CAT)、改良的英国医学研究委员会呼吸困难量表(Modified Medical Research Council Dyspnea Scale,MMRC),记录两组患者入院时及出院后1个月、3个月、6个月时MNA、CAT、MMRC评分变化情况,分析两组患者各指标随时间变化情况,以及MNA评分与CAT、MMRC评分的相关关系。结果观察组主要健康问题在环境领域、社会心理领域、生理领域、健康相关行为领域均有分布,其中以健康相关行为领域居多。对实验结果进行简单效应分析,两组患者CAT、MMRC、MNA量表评分在入院时与出院后1个月、3个月、6个月比较,差异均有统计学意义(P <0. 05),干预方法和时间存在交互效应(P <0. 05)。两组患者各量表评分差异在入院时无统计学意义,在出院后1个月、3个月、6个月之间差异有统计学意义(P <0. 05)。Pearson相关关系分析提示,MNA评分与CAT、MMRC评分呈显著负相关(r=-0. 493,r=-0. 594; P <0. 05)。结论采用奥马哈系统护理模式对营养不良COPD患者进行营养干预,可以明显改善患者的营养情况,随着时间推移,营养改善更明显,从而提高营养不良COPD患者生活质量。
An 82-year-old man was presented with dizziness for 30 years and progressive severity of nausea for one month. He was diagnosed as hypertension. He stopped taking antihypertensive drugs one year before the present hospitalization. The man was given zolpidem 10mg, once per night by mouth due to insomnia. 20 minutes after the second administration, the patient developed abnormal behavior and incorrect response. Physical examination showed inabilities of orientation, calculation and memory, mild stiff neck and positive Hoffmann sign. The man had no family history of mental disorders in the past. The above symptoms did not recur after withdrawal of zolpidem. It seems reasonable to link his symptoms to zolpidem treatment.
