提高神经外科重症患者肠内营养耐受性的循证护理实践

The evidence based practice of improving enteral nutrition tolerance in critical neurosurgical patients

目的探讨基于临床实践指南相关证据的循证护理实践对神经外科重症患者肠内营养耐受性的影响.方法便利选取2018年1月—11月在荆州市某三级甲等医院神经外科重症监护室收治的重症患者144例,其中2018年7月—11月的69例患者为试验组,2018年1月—6月的75例患者为对照组.试验组进行基于临床实践指南相关证据的循证护理干预,对照组接受常规护理,比较两组肠内营养不耐受的发生率、喂养达标率、护士肠内营养知识"知信行"调查得分情况.结果与对照组相比,试验组肠内营养不耐受发生率明显下降(P<0.05);试验组7 d喂养达标为94.2%,两组差异有统计学意义(x2=12.585,P<0.001);护士层面,护士对重症患者喂养不耐受症状管理的相关知识水平显著提高(P<0.05).结论早期引入基于临床实践指南证据的循证护理方案对于改善神经外科重症患者肠内营养耐受性具有重要作用.

Objective To investigate the effects of evidence-based nursing practice according to clinical practice guidelines on enteral nutrition tolerance in critical neurosurgical patients.Methods 144 critical patients admitted to the intensive care unit of neurosurgical department in a tertiary hospital in Jingzhou City from January 2018 to November 2018 were selected by convenient sampling.69 patients who were admitted from July to November 2018 were defined as the experimental group and 75 patients who were admitted from January to June 2018 as the control group.The control group received routine nursing care while the experimental group received evidence-based nursing intervention based on clinical practice guidelines.The incidence rate of enteral nutrition intolerance and feeding compliance rate were compared between the two groups.The nurses’scores of"knowledge,belief and practice of enteral nutrition"were also compared between the two groups.Results Compared with the control group,the incidence rate of enteral nutrition intolerance in the experimental group was significantly lower(P<0.05).The compliante rate of 7 d feeding in the experimental group was 94.2%,the difference between the two groups was statistically significant(x2=12.585,P<0.001).The knowledge level of nurses on the management of feeding intolerance in severe patients was significantly improved(P<0.05).Conclusion The early introduction of evidence-based nursing practice based on clinical practice guidelines plays an important role in improving enteral nutrition tolerance in critical neurosurgical patients.