危重症患者肠内营养不耐受预防及管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2019.12.021

摘要/Abstract

摘要：

目的检索并获取危重症患者肠内营养喂养不耐受预防及管理的相关证据,为临床提供参考。方法应用循证护理的方法,针对成人危重症患者肠内营养喂养不耐受预防及管理提出问题,按照“6S”模型检索文献,采用澳大利亚JBI循证卫生保健中心的文献评价标准和证据分级系统（2014版）对各类研究进行文献质量评价及证据级别评定。结果结合专业人员的判断,汇总出22条危重症患者肠内营养喂养不耐受预防及管理的证据,包括喂养不耐受性评估、喂养不耐受危险因素、营养制剂配方管理、肠内营养喂养策略（喂养的途径、速度、温度）、体位管理、胃残余量监测、药物应用、腹内压监测与管理和中医疗法等9个方面。结论本研究总结了目前关于危重症患者肠内营养喂养不耐受预防及管理的最佳证据,为规范ICU护士实施肠内营养支持护理行为提供循证依据,以科学的护理方法来管理危重症患者肠内营养喂养不耐受的问题,提升护理质量。

关键词: 肠道营养, 喂养不耐受, 重症监护, 循证护理学

Abstract:

Objective To select and obtain the best evidence of prevention and management of feeding intolerance（FI） in critically ill patients with enteral nutrition support so as to provide guidance for clinical practitioners to reduce the incidence rate of FI. Methods Using the method of evidence-based nursing,clinical question of FI prevention and management in critically ill patients with enteral nutrition support was raised. Relevant research was retrieved by computer search. JBI evidence appraisal tools and recommendation system were used to evaluate quality of studies and level of evidence. Results Combined with the judgment of clinical professionals,totally 22 items of evidence were selected,including FI assessment,risk factors of FI,enteral formula management,enteral feeding pathway,position management,gastric residual quantity monitoring,drug administration,intra-abdominal pressure monitoring and traditional Chinese medicine therapy,etc. Conclusion This study summarized the best evidence for prevention and management of FI in critically ill patients with enteral nutrition support and help clinical nurses and nursing administrators with decision making,ultimately through adapting the best evidence and using scientific nursing methods to cope with the clinical problems and improve nursing quality.

Key words: Enteral nutrition, Feeding Intolerance, Intensive care, Evidence-Based Nursing

米元元, 黄培培, 董江, 蔡喆燚, 吴白女, 王励飞, 孙亮, 詹昱新, 明耀辉, 李巧云, 李素云, 罗健, 黄海燕. 危重症患者肠内营养不耐受预防及管理的最佳证据总结[J]. 中华护理杂志, 2019, 54(12): 1868-1876.

MI Yuanyuan, HUANG Peipei, DONG Jiang, CAI Zheyi, WU Bainü, WANG Lifei, SUN Liang, ZHAN Yuxin, MING Yaohui, LI Qiaoyun, LI Suyun, LUO Jian, HANG Haiyan. Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients[J]. Chinese Journal of Nursing, 2019, 54(12): 1868-1876.

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