以腹内压监测为导向的腹腔高压患者肠内营养护理方案的构建及应用

doi:10.3761/j.issn.0254-1769.2023.12.001

摘要/Abstract

摘要：

目的构建并应用以腹内压监测为导向的腹腔高压患者肠内营养护理方案，为腹腔高压患者实施肠内营养提供系统、规范的干预措施，以降低患者喂养不耐受发生率，提高喂养达标率。方法通过查阅文献和德尔菲专家函询，构建以腹内压监测为导向的腹腔高压患者肠内营养护理方案，采用方便抽样法，2022年1月—10月选择218例入住浙江省某三级甲等医院急诊ICU的腹腔高压患者作为应用对象，试验组采用以腹内压监测为导向的腹腔高压患者肠内营养护理方案进行肠内营养治疗，对照组采用ICU常规肠内营养治疗。比较两组喂养不耐受症状发生率，肠内营养第3、7天的目标热量达标率，肠内营养持续天数，ICU入住天数。结果试验组喂养不耐受症状发生率为58.70%，低于对照组的74.31%；试验组肠内营养第3天目标热量达标率为31.19%，高于对照组的16.51%；试验组肠内营养第7天目标热量达标率为28.44%，高于对照组的13.76%，两组比较，差异均具有统计学意义（均P<0.05）。两组肠内营养持续天数、ICU入住天数比较，差异均无统计学意义（均P>0.05）。结论以腹内压监测为导向的腹腔高压患者肠内营养护理方案具有临床指导意义，可降低腹腔高压患者喂养不耐受症状发生率，提高喂养达标率。

关键词: 重症监护, 腹内压, 肠内营养, 喂养不耐受, 护理

Abstract:

Objective To construct and apply an enteral nutrition protocol for patients with intra-abdominal hypertension oriented by intra-abdominal pressure，and provide systematic and standardized interventions for the implementation of enteral nutrition for patients with intra-abdominal hypertension，to reduce the incidence of feeding intolerance and improve the feeding compliance rate. Methods Through literature review and the Delphi method，the enteral nutrition protocol for patients with intra-abdominal hypertension was constructed，and 218 patients with intra-abdominal hypertension admitted to the emergency ICU of a tertiary hospital in Zhejiang Province from January to October 2022 were selected by convenient sampling method. The experimental group used the enteral nutrition protocol for patients with intra-abdominal hypertension oriented by intra-abdominal pressure for enteral nutrition treatment，and the control group used the conventional enteral nutrition treatment in ICU. The incidence of feeding intolerance symptoms，the feeding compliance rate on the 3rd and 7th day of enteral nutrition，the duration of enteral nutrition，and the number of days in ICU were compared between the 2 groups. Results The incidence of feeding intolerance symptoms in the experimental group（58.70%） was lower than that in the control group（74.31%）；the feeding compliance rate on the 3rd day of enteral nutrition（31.19%） was higher than that in the control group （16.51%）；the rate of feeding on the 7th day of enteral nutrition（28.44%） was higher than that in the control group（13.76%），and the differences were statistically significant（all P<0.05）. There was no significant difference in the duration of enteral nutrition and ICU stay between the 2 groups（all P>0.05）. Conclusion The enteral nutrition protocol for patients with intra-abdominal hypertension oriented by intra-abdominal pressure has clinical guiding significance，which can reduce the incidence of feeding intolerance and improve the feeding compliance rate in patients with intra-abdominal hypertension.

Key words: Intensive Care, Intra-Abdominal Pressure, Enteral Nutrition, Feeding Intolerance, Nursing Care

袁梦湄, 黄晓霞, 唐佳迎, 封秀琴. 以腹内压监测为导向的腹腔高压患者肠内营养护理方案的构建及应用[J]. 中华护理杂志, 2023, 58(12): 1413-1421.

YUAN Mengmei, HUANG Xiaoxia, TANG Jiaying, FENG Xiuqin. Construction and application of enteral nutrition protocol for patients with intra-abdominal hypertension oriented by intra-abdominal pressure[J]. Chinese Journal of Nursing, 2023, 58(12): 1413-1421.

图/表 3

表1 以腹内压监测为导向的腹腔高压患者肠内营养护理方案专家函询结果（第2轮）

Table 1 Results of expert consultation of the enteral nutrition protocol for patients with intra-abdominal hypertension oriented by intra-abdominal pressure（the second round）

表2 两组一般资料的比较

Table 2 Comparison of general data between the 2 groups

表3 两组喂养不耐受症状发生情况的比较[例（百分率，%）]

Table 3 Comparison of the incidence of feeding intolerance symptoms between the 2 groups[case（percentage，%）]

参考文献 29

[1]	Khot Z, Murphy PB, Sela N, et al. Incidence of intra-abdominal hypertension and abdominal compartment syndrome:a systematic review[J]. J Intensive Care Med, 2021, 36(2):197-202. DOI URL
[2]	陈丽花, 盛青青, 黄瑶, 等. 重症患者腹内高压预防与管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(17):2164-2170. DOI URL
	Chen LH, Sheng QQ, Huang Y, et al. Summary of best evidence on preventing and management of intra-abdominal hypertension in critically ill patients[J]. Chin J Nurs, 2022, 57(17):2164-2170. DOI URL
[3]	Reintam Blaser A, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients:ESICM clinical practice guidelines[J]. Intensive Care Med, 2017, 43(3):380-398. DOI PMID
[4]	陈亭, 王婷, 李清, 等. 重症急性胰腺炎患者肠内营养喂养不耐受状况及其影响因素研究[J]. 中华护理杂志, 2017, 52(6):716-720.
	Chen T, Wang T, Li Q, et al. Current status and influencing factors of enteral feeding intolerance in patients with severe acute pancreatitis[J]. Chin J Nurs, 2017, 52(6):716-720.
[5]	Du LQ, Zhao YY, Yin CH, et al. Application of intra-abdominal pressure monitoring in early enteral nutrition after abdominal surgery[J]. Am J Transl Res, 2021, 13(6):7140-7147. PMID
[6]	袁梦湄, 唐佳迎, 黄晓霞, 等. 腹内压监测在腹腔高压患者肠内营养中的应用进展[J]. 中华护理杂志, 2022, 57(19):2353-2357. DOI URL
	Yuan MM, Tang JY, Huang XX, et al. Research progress on the application of intra-abdominal pressure monitoring in enteral nutrition for patients with abdominal hypertension[J]. Chin J Nurs, 2022, 57(19):2353-2357. DOI URL
[7]	赵丽丽, 杨世豪, 高永芳, 等. 腹内压监测在急性呼吸窘迫综合征机械通气病人肠内营养中的应用[J]. 肠外与肠内营养, 2019, 26(3):174-178.
	Zhao LL, Yang SH, Gao YF, et al. Application of intra-abdominal pressure monitoring in enteral nutrition of patients with mechanical ventilation after Acute Respiratory Distress Syndrome[J]. Parenter & Enter Nutr, 2019, 26(3):174-178.
[8]	Mahran G, Mahgoup A, Kamel EZ, et al. Effect of 2 enteral feeding schedules on intra-abdominal pressure in patients receiving mechanical ventilation:a randomized controlled trial[J]. Crit Care Nurse, 2019, 39(6):29-35. DOI PMID
[9]	薛瑾, 周金红, 倪兴梅, 等. 肠内营养耐受性评估管理方案在重症急性胰腺炎合并腹腔高压患者中的运用[J]. 护理实践与研究, 2022, 19(2):305-309.
	Xue J, Zhou JH, Ni XM, et al. Application of enteral nutrition tolerance assessment and management program in patients with severe acute pancreatitis and abdominal hypertension[J]. Nurs Pract Res, 2022, 19(2):305-309.
[10]	刘珊珊, 谢波, 徐菊玲, 等. ICU机械通气患者肠内营养不同输注速度对腹内压及喂养不耐受的影响[J]. 湖州师范学院学报, 2019, 41(4):64-67.
	Liu SS, Xie B, Xu JL, et al. Effects of different infusion velocity of enteral nutrition on intra-abdominal pressure and feeding intolerance in mechanical ventilation patients in ICU[J]. J Huzhou Univ, 2019, 41(4):64-67.
[11]	杨丽, 孟宪熙, 唐寒芬, 等. 重度烧伤患者肠内营养护理规范的循证实践[J]. 中华烧伤杂志, 2017, 33(1):53-55.
	Yang L, Meng XX, Tang HF, et al. Evidence-based practice of enteral nutrition nursing standard for severe burn patients[J]. Chin J Burns, 2017, 33(1):53-55.
[12]	刘珊珊. ICU重症患者腹内压与喂养不耐受相关性研究[D]. 湖州: 湖州师范学院, 2019.
	Liu SS. Correlation between intra-abdominal pressure and feeding intolerance in critically ill patients in ICU[D]. Huzhou: Huzhou University, 2019.
[13]	中国腹腔重症协作组. 重症患者腹内高压监测与管理专家共识(2020版)[J]. 中华消化外科杂志, 2020, 19(10):1030-1037.
	Chinese Abdominal Intensive Care Association. Expert consensus on monitoring and management of intra-abdominal hypertension in severe patients(2020 edition)[J]. Chin J Dig Surg, 2020, 19(10):1030-1037.
[14]	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 edition)[J]. Chin Crit Care Med, 2021, 33(8):903-918.
[15]	孙仁华. 重症患者早期肠内营养临床实践专家共识[J]. 中华危重病急救医学, 2018, 30(8):715-721.
	Sun RH. Consensus of early enteral nutrition clinical practice in critically ill patients[J]. Chin Crit Care Med, 2018, 30(8):715-721.
[16]	Lee RK, Gallagher JJ, Ejike JC, et al. Intra-abdominal hypertension and the open abdomen:nursing guidelines from the Abdominal Compartment Society[J]. Crit Care Nurse, 2020, 40(1):13-26. DOI URL
[17]	许静涌, 杨剑, 康维明, 等. 营养风险及营养风险筛查工具营养风险筛查2002临床应用专家共识(2018版)[J]. 中华临床营养杂志, 2018, 26(3):131-135.
	Xu JY, Yang J, Kang WM, et al. Nutrition risk and nutrition risk screening tool expert consensus on clinical application of nutrition risk screening in 2002(2018 edition)[J]. Chin J Clin Nutr, 2018, 26(3):131-135.
[18]	中华护理学会. 成人肠内营养支持的护理[EB/OL]. (2021-02-01) [2022-12-30]. http://www.bjhlxh.com/about/1811.html.
	Chinese Nursing Society. Nursing care of adult enteral nutrition support[EB/OL]. (2021-02-01) [2022-12-30]. http://www.bjhlxh.com/about/1811.html.
[19]	Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit[J]. Clin Nutr, 2019, 38(1):48-79. DOI PMID
[20]	Blaser AR, Malbrain MLNG, Starkopf J, et al. Gastrointestinal function in intensive care patients:terminology,definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems[J]. Intensive Care Med, 2012, 38(3):384-394. DOI URL
[21]	McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient:Society of Critical Care Medicine(SCCM) and American Society for Parenteral and Enteral Nutrition(A.S.P.E.N.)[J]. JPEN J Parenter Enteral Nutr, 2016, 40(2):159-211. DOI URL
[22]	封秀琴, 蔡凌云, 周佳佳, 等. 15例特重度烧伤俯卧位通气患者早期幽门后喂养不减速的护理[J]. 中华护理杂志, 2021, 56(5):748-750. DOI URL
	Feng XQ, Cai LY, Zhou JJ, et al. Nursing care of non-slow down post-pyloric feeding for 15 severe burn patients with prone ventilation[J]. Chin J Nurs, 2021, 56(5):748-750. DOI URL
[23]	张伟, 江海娇, 姜小敢, 等. 危重病人肠内营养喂养不耐受危险因素的Meta分析[J]. 肠外与肠内营养, 2020, 27(5):313-320.
	Zhang W, Jiang HJ, Jiang XG, et al. Risk factors of enteral feeding intolerance in critical ill patients:a Meta-analysis[J]. Parenter & Enter Nutr, 2020, 27(5):313-320.
[24]	Qiu CF, Chen CX, Zhang WX, et al. Fat-modified enteral formula improves feeding tolerance in critically ill patients:a multicenter,single-blind,randomized controlled trial[J]. JPEN J Parenter Enteral Nutr, 2017, 41(5):785-795. DOI URL
[25]	朱苑霞, 郑燕华, 蔡艳. ICU机械通气患者腹内压与肠内营养喂养不耐受的相关性[J]. 护理实践与研究, 2021, 18(2):175-178.
	Zhu YX, Zheng YH, Cai Y. Correlation between intra-abdominal pressure and enteral nutrition feeding intolerance in patients with mechanical ventilation in ICU[J]. Nurs Pract Res, 2021, 18(2):175-178.
[26]	葛梓, 曹隽, 赵晖, 等. 腹内压监测对于实施早期肠内营养急性胰腺炎患者疗效评估的作用分析[J]. 中华危重病急救医学, 2022, 34(6):630-634.
	Ge Z, Cao J, Zhao H, et al. Assessment of effects of intra-abdominal pressure monitoring on evaluating early enteral nutrition in patients with acute pancreatitis[J]. Chin Crit Care Med, 2022, 34(6):630-634.
[27]	Pu H, Doig GS, Heighes PT, et al. Early enteral nutrition reduces mortality and improves other key outcomes in patients with major burn injury:a meta-analysis of randomized controlled trials[J]. Crit Care Med, 2018, 46(12):2036-2042. DOI URL
[28]	叶向红, 彭南海, 江方正, 等. 重症急性胰腺炎合并腹腔高压患者早期肠内营养耐受性的管理[J]. 中华护理杂志, 2016, 51(12):1439-1442.
	Ye XH, Peng NH, Jiang FZ, et al. Early enteral nutrition tolerance management of severe acute pancreatitis patients complicated with intra-abdominal hypertension[J]. Chin J Nurs, 2016, 51(12):1439-1442.
[29]	Landais M, Nay MA, Auchabie J, et al. Continuous enteral nutrition compared with a maximal gastric vacuity strategy at the time of extubation in the intensive care unit:protocol for a non-inferiority cluster randomised trial(the Ambroisie Project)[J]. BMJ Open, 2021, 11(5):e041799.