成人重度烧伤患者肠内肠外营养的证据总结

doi:10.3761/j.issn.0254-1769.2024.09.012

摘要/Abstract

摘要：

目的系统检索并整合成人重度烧伤患者肠内肠外营养的证据。方法由2名经过系统学习循证护理学的研究生检索国内外指南网、相关机构网站及数据库内有关成人重度烧伤患者肠内肠外营养的临床决策、推荐实践、指南、专家共识、系统评价、证据总结等文献，检索时限为建库至2023年4月。由2名具有硕士学历且经过复旦大学循证培训的研究人员采用评价工具对文献进行方法学质量评价，并根据主题对证据进行提取与汇总。结果纳入28篇文献，包括临床决策1篇、指南9篇、专家共识3篇、系统评价9篇、证据总结6篇，从营养风险筛查和评估、能量需求计算、营养支持时机与途径、营养素摄入、营养支持监测及效果评价6个方面总结了20条证据。结论该研究总结的成人重度烧伤患者肠内肠外营养的证据较为全面、科学，建议临床应用时，根据证据的促进及阻碍因素等进行针对性的筛选，科学开展成人重度烧伤患者的营养支持。

关键词: 烧伤, 营养支持, 肠内营养, 肠外营养, 循证护理学

Abstract:

Objective To systematically retrieve and integrate the best evidence of enteral and parenteral nutrition support in adult patients with severe burns. Methods 2 nursing master students who had studied evidence-based nursing systematically searched the clinical decisions，recommended practices，guidelines，expert consensuses，systematic reviews，evidence summaries and other evidences on enteral and parenteral nutrition support for adult patients with severe burns in domestic and foreign guideline networks，relevant institutional websites and databases. The retrieval time was from the establishment of the databases to April 2023. 2 researchers who had obtained master’s degrees and undergone systematic evidence-based training in Fudan University used the appraisal of guidelines for research and evaluation Ⅱ and JBI critical appraisal tools to evaluate the methodological quality，and extracted and summarized the evidence according to the theme. Results A total of 28 articles were included，including 1 clinical decision，9 guidelines，3 expert consensuses，9 systematic reviews，and 6 evidence summaries. A total of 20 pieces of evidence were summarized from 6 aspects：nutritional risk screening and assessment，energy requirement calculation，timing and route of nutritional support，nutrient intake，nutritional support monitoring and effect evaluation. Conclusion The best evidence of enteral and parenteral nutrition support for adult patients with severe burns summarized in this study is more comprehensive and scientific. It is suggested that in clinical application，targeted screening should be carried out according to the promotion and hindering factors of evidence，so as to scientifically carry out nutritional support for adult patients with severe burns.

Key words: Burns, Nutritional Support, Enteral Nutrition, Parenteral Nutrition, Evidence-Based Nursing

谢玉生, 黄蓉蓉, 赵雪, 马蕾, 胡雁, 杨倩, 王乾沙, 明玥. 成人重度烧伤患者肠内肠外营养的证据总结[J]. 中华护理杂志, 2024, 59(9): 1106-1113.

XIE Yusheng, HUANG Rongrong, ZHAO Xue, MA Lei, HU Yan, YANG Qian, WANG Qiansha, MING Yue. Evidence summary of enteral and parenteral nutrition support in adult patients with severe burns[J]. Chinese Journal of Nursing, 2024, 59(9): 1106-1113.

图/表 5

图1 PubMed和中国生物医学文献数据库的检索策略

Figure 1 Search strategies of PubMed and Chinese Biomedical Literature Database

图2 文献筛选流程图

Figure 2 The flow diagram of literature screening

表1 纳入文献的基本特征（n=28）

Table 1 Characteristics of included literature（n=28）

表2 纳入指南的方法学质量评价结果（n=9）

Table 2 Quality evaluation results of included guidelines（n=9）

表3 成人重度烧伤患者肠内肠外营养的证据总结

Table 3 Evidence summary of enteral and parenteral nutrition support in adult patients with severe burns

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