重症肺炎患者营养管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2024.13.012

摘要/Abstract

摘要：

目的筛选、汇总重症肺炎患者营养管理的证据，为医护人员开展重症肺炎患者的营养管理提供循证依据。方法系统检索BMJ Best Practice、UpToDate、美国国立指南网、国际指南协作网、加拿大安大略省注册护士协会网站、英国国家卫生与临床优化研究所网站、Cochrane Library、OVID（包括澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库和Medline）、PubMed、Embase、Web of Science、CINAHL、中华医学期刊全文数据库、中国知网、维普数据库、万方数据库、中国生物医学文献数据库及美国肠内肠外营养学会网站、欧洲临床营养与代谢学会网站、美国重症医学会网站、欧洲重症监护医学会网站中关于重症肺炎患者营养管理的证据，包括临床决策、指南、系统评价、专家共识、证据总结。检索时限为2012年1月1日—2022年12月31日。由2名研究者对纳入文献进行质量评价后，按主题对证据进行提取和汇总。结果共纳入13篇文献，包括3篇临床决策、4篇指南、1篇系统评价、5篇专家共识，从组建团队、营养筛查与评估、营养需求、营养干预、营养监测及健康教育6个方面总结了24条证据。结论该研究证据总结过程规范，汇总的证据内容较为全面，医护人员应结合临床实际情境、患者及家属意愿选择最佳证据，从而改善患者的预后。

关键词: 重症肺炎, 营养管理, 循证护理学, 证据总结, 肠内营养, 肠外营养

Abstract:

Objective To summarize the best evidence of nutrition management in patients with severe pneumonia，aiming to offer evidence-based guidance for clinical healthcare professionals. Methods All evidence on nutrition management in patients with severe pneumonia was retrieved from various databases and websites including BMJ Best Practice，UpToDate，National Guideline Clearinghous（NGC），Guidelines International Network（GIN），Registered Nurses’ Association of Ontario（RNAO），National Institute for Health and Care Excellence（NICE），Cochrane Library，OVID，PubMed，Embase，Web of Science，CINAHL，Chinese Medical Journal Full-text Database，CNKI，VIP，Wanfang，CBM，American Society for Parenteral and Enteral Nutrition（ASPEN），European Society for Clinical Nutrition and Metabolism（ESPEN），Society of Critical Care Medicine（SCCM） and European Society of Intensive Care Medicine（ESICM）. The retrieved evidence included clinical decisions，guidelines，systematic reviews，expert consensuses and evidence summaries. The search period ranged from January 1st，2012 to December 31st，2022. There were 2 researchers who independently assessed the quality of the included studies and then extracted and summarized the evidence by topic. Results A total of 13 articles were involved，including 3 clinical decisions，4 guidelines，1 systematic review，and 5 expert consensuses. A total of 24 pieces of evidence were summarized across 6 aspects which encompassed team building，nutrition screening and assessment，nutritional requirements，nutrition intervention，nutrition monitoring，and health education. Conclusion The production process of this evidence summary followed standardized procedures，ensuring comprehensive content. Medical professionals should integrate clinical conditions，patient factors，and family preferences to select the most optimal evidence in order to enhance patient prognosis and improve medical quality.

Key words: Severe Pneumonia, Nutrition Management, Evidence-Based Nursing, Evidence Summary, Enteral Nutrition, Parenteral Nutrition

游俊杰, 刘波, 陈梦玲, 沈玉珊, 郑思琳, 黄敏. 重症肺炎患者营养管理的最佳证据总结[J]. 中华护理杂志, 2024, 59(13): 1616-1623.

YOU Junjie, LIU Bo, CHEN Mengling, SHEN Yushan, ZHENG Silin, HUANG Min. Summary of the best evidence for nutritional management in patients with severe pneumonia[J]. Chinese Journal of Nursing, 2024, 59(13): 1616-1623.

图/表 4

图1 文献筛选流程

Figure 1 Flow chart of literature screening

表1 纳入文献的基本特征（n=13）

Table 1 The basic characteristics of the included literature（n=13）

表2 纳入指南的质量评价结果（n=4）

Table 2 Quality evaluation results of the guidelines（n=4）

表3 重症肺炎患者营养管理的最佳证据总结

Table 3 Summary of the best evidence for nutritional management in patients with severe pneumonia

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