重症患者肠内营养管理系统的构建与应用研究

doi:10.3761/j.issn.0254-1769.2025.11.014

摘要/Abstract

摘要：

目的开发重症患者肠内营养管理系统，并评价其应用效果，以规范肠内营养管理。方法基于相关指南及指标体系，构建重症患者肠内营养管理系统，包括营养筛查及评估、肠内营养实施、肠内营养监测、统计分析4个模块。采用便利抽样法，选取宁波市某三级甲等医院ICU的肠内营养患者和医护人员作为研究对象，将2024年1月— 2月作为试验组数据来源时间，2023年1月—2月作为对照组数据来源时间。比较两组营养风险筛查率、每日喂养中断率、肠内营养计划完成率及并发症发生率，并采用临床护理信息系统有效性评价表，由医护人员评价系统的有效性。结果试验组纳入111例患者，对照组纳入101例患者。试验组营养风险筛查率、肠内营养计划完成率均高于对照组，试验组每日喂养中断率、机械性并发症发生率均低于对照组，差异均具有统计学意义（P<0.05）。临床护理信息系统有效性评价表得分为（104.73±9.34）分。结论应用重症患者肠内营养管理系统有助于提高营养风险筛查率及肠内营养计划完成率，降低每日喂养中断率及机械性并发症发生率，医护人员对该系统的评价较高。

关键词: 重症监护病房, 肠内营养, 信息管理系统, 护理

Abstract:

Objective To develop an enteral nutrition management system for critically ill patients and assess its application outcomes to standardize enteral nutrition management. Methods Based on relevant guidelines and indicator systems，a management system for enteral nutrition in critically ill patients was constructed，consisting of 4 modules：nutritional screening and assessment，nutritional implementation，nutritional monitoring，and statistical analysis. A convenience sampling method was used to select enteral nutrition patients and healthcare staff from the ICU of a tertiary hospital in Ningbo. Data from January to February 2024 served as an experimental group，while data from January to February 2023 constituted a control group. The 2 groups were compared regarding nutritional risk screening rate，feeding interruption rate，completion rate of the enteral nutrition plan，and incidence of complications. At the same time，the system’s effectiveness was assessed by healthcare professionals using the clinical nursing information system effectiveness evaluation form. Results The study included 111 patients in the experimental group and 101 patients in the control group. The experimental group exhibited a significantly higher nutritional risk screening rate and enteral nutrition plan completion rate，as well as significantly lower feeding interruption rate and incidence of mechanical complications compared to the control group（P<0.05）. The system received a high effectiveness rating，with an average score of 104.73±9.34. Conclusion The application of the enteral nutrition management system effectively improves the nutritional risk screening rate and completion rate of enteral nutrition plans，while reducing both the feeding interruption rate and the incidence of mechanical complications. Healthcare staff highly rated the system.

Key words: Intensive Care Units, Enteral Nutrition, Information Management System, Nursing Care

张黎, 吴怡雪, 陈芳芳, 张一清, 郑施, 徐慧娜. 重症患者肠内营养管理系统的构建与应用研究[J]. 中华护理杂志, 2025, 60(11): 1373-1379.

ZHANG Li, WU Yixue, CHEN Fangfang, ZHANG Yiqing, ZHENG Shi, XU Huina. Construction and application of an enteral nutrition management system for critically ill patients[J]. Chinese Journal of Nursing, 2025, 60(11): 1373-1379.

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参考文献 18

[1]	中华医学会重症医学分会. 中国成人ICU患者营养评估与监测临床实践指南[J]. 中华危重病急救医学, 2023, 35(11):1121-1146. PMID
	Chinese Society of Critical Care Medicine. Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China[J]. Chin Crit Care Med, 2023, 35(11):1121-1146. DOI PMID
[2]	中华医学会肠外肠内营养学分会. 中国成人患者肠外肠内营养临床应用指南(2023版)[J]. 中华医学杂志, 2023, 103(13):946-974.
	Chinese Society of Parenteral and Enteral Nutrition. Guideline for clinical application of parenteral and enteral nutrition in adults patients in China(2023 edition)[J]. Natl Med J China, 2023, 103(13):946-974.
[3]	Mehta NM, Skillman HE, Irving SY, et al. Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient:society of critical care medicine and American society for parenteral and enteral nutrition[J]. Pediatr Crit Care Med, 2017, 18(7):675-715.
[4]	姜悦, 皇海萍, 潘慧斌. 信息化动态管理方案在肠内营养相关性腹泻患者中的应用研究[J]. 护理与康复, 2024, 23(11):54-57.
	Jiang Y, Huang HP, Pan HB. Study on the application of information dynamic management scheme in patients with ente-ral nutrition-related diarrhea[J]. J Nurs Rehabil, 2024, 23(11):54-57.
[5]	蔡益虹, 颜小玲, 柯晓晖, 等. 基于循证护理的信息化动态管理在ICU患者肠内营养支持中的应用[J]. 中国医药指南, 2024, 22(28):37-40.
	Cai YH, Yan XL, Ke XH, et al. Application of dynamic infor-mation management based on evidence nursing in enteral nu-trition support of ICU patients[J]. Guide China Med, 2024, 22(28):37-40.
[6]	诸小飞, 王娇, 潘慧斌, 等. 信息化引导下肠内营养相关性腹泻处置流程在慢性阻塞性肺疾病持续无创辅助通气患者中的应用效果分析[J]. 中华危重病急救医学, 2024, 36(1):62-66.
	Zhu XF, Wang J, Pan HB, et al. Effect analysis of information-guided enteral nutrition-associated diarrhea treatment process in patients with chronic obstructive pulmonary disease under-going continuous non-invasive assisted ventilation:a mixed cohort study of pre- and post-control[J]. Chin Crit Care Med, 2024, 36(1):62-66.
[7]	张献娜, 叶向红, 高岚, 等. 肠内营养护理示范单位(病房)指标体系及评价细则构建[J]. 中华临床营养杂志, 2024, 32(3):129-137.
	Zhang XN, Ye XH, Gao L, et al. Construction of an evaluation framework with detailed indices for enteral nutrition nursing demonstration units(wards)[J]. Chin J Clin Nutr, 2024, 32(3):129-137.
[8]	叶向红, 朱冬梅, 邵小平, 等. 重症患者肠内营养护理[M]. 南京: 东南大学出版社, 2021:86.
	Ye XH, Zhu DM, Shao XP, et al. Enteral nutrition care of critically ill patients[M]. Nanjing: Southeast University Press, 2021:86.
[9]	中华护理学会. 成人肠内营养支持的护理[EB/OL].(2021-02-01)[2024-12-30]. http://hltb.kxj.org.cn/index/tuanti/standard.html?team_standard_id=26.
	Chinese Nursing Society. Nursing care of adult enteral nutri-tion support[EB/OL].(2021-02-01)[2024-12-30]. http://hltb.kxj.org.cn/index/tuanti/standard.html?team_standard_id=26.
[10]	Kim H, Stotts NA, Froelicher ES, et al. Adequacy of early en-teral nutrition in adult patients in the intensive care unit[J]. J Clin Nurs, 2012, 21(19/20):2860-2869.
[11]	赵永信, 顾莺, 张晓波, 等. 基于新D&M模型的《临床护理信息系统有效性评价量表》的编制及信效度评价[J]. 中国实用护理杂志, 2020, 36(7):544-550.
	Zhao YX, Gu Y, Zhang XB, et al. The development of the Clinical Nursing Information System Effectiveness Evaluation Scale based on the new D & M model and the conduction of reliability and validity evaluation[J]. Chin J Pract Nurs, 2020, 36(7):544-550.
[12]	Lew CCH, Yandell R, Fraser RJL, et al. Association between malnutrition and clinical outcomes in the intensive care unit:a systematic review[J]. JPEN J Parenter Enteral Nutr, 2017, 41(5):744-758.
[13]	米元元, 卢洁. 重症患者肠内营养中断影响因素及干预策略的研究进展[J]. 护士进修杂志, 2022, 37(10):886-891.
	Mi YY, Lu J. Research progress in influence factors and intervention strategies of enteral nutrition interruption in critically ill patients[J]. J Nurses Train, 2022, 37(10):886-891.
[14]	刘欢, 杜爱平, 张耀丹, 等. 重症患者气道操作相关肠内营养喂养中断的研究进展[J]. 中华护理杂志, 2024, 59(12):1525-1530. DOI
	Liu H, Du AP, Zhang YD, et al. Research progress of feeding interruption during airway procedures in critically ill patients with enteral nutrition[J]. Chin J Nurs, 2024, 59(12):1525-1530. DOI
[15]	米元元, 黄海燕, 尚游, 等. 中国危重症患者肠内营养治疗常见并发症预防管理专家共识(2021版)[J]. 中华危重病急救医学, 2021, 33(8):903-918.
	Mi YY, Huang HY, Shang Y, et al. Expert consensus on prevention and management of enteral nutrition therapy complications for critically ill patients in China(2021 edi-tion)[J]. Chin Crit Care Med, 2021, 33(8):903-918.
[16]	张志焕, 张献娜, 叶向红, 等. 287家肠内营养“示范病房”建设单位临床护士营养护理能力现状及影响因素分析[J]. 中华临床营养杂志, 2024, 32(4):198-206.
	Zhang ZH, Zhang XN, Ye XH, et al. Analysis on the status quo and influencing factors of nutrition nursing competence of clinical nurses in 287 enteral nutrition demonstration wards[J]. Chin J Clin Nutr, 2024, 32(4):198-206.
[17]	全殷殷, 张帅, 陈娟红, 等. ICU患者早期肠内营养耐受性监测系统的构建与应用[J]. 中华护理杂志, 2022, 57(7):773-778. DOI
	Quan YY, Zhang S, Chen JH, et al. Construction and appli-cation of early enteral nutrition tolerance monitoring system for ICU patients[J]. Chin J Nurs, 2022, 57(7):773-778.
[18]	陈利, 杨又. 区块链技术在临床护理中的应用进展[J]. 中华护理杂志, 2024, 59(2):250-256. DOI
	Chen L, Yang Y. Research progress of blockchain technology in clinical nursing[J]. Chin J Nurs, 2024, 59(2):250-256. DOI