ICU患者肠内营养并发腹泻证据汇总

Evidences for Diarrhea during Enteral Nutrition Support in Critical Ill Patients

目的检索并获取ICU患者实施肠内营养支持期间并发腹泻的相关证据,为ICU相关科室提供参考,以降低ICU患者肠内营养腹泻的发生率。方法应用循证护理的方法,针对实施肠内营养支持并发腹泻提出问题,并使用计算机检索引擎检索关于肠内营养支持并发腹泻的相关研究,采用约翰霍普金斯循证护理实践模型对各类研究进行文献质量评价及证据级别评定。结果结合专业人员的判断,汇总出33条ICU患者肠内营养支持并发腹泻的证据,包括腹泻的识别、评估、肠内营养腹泻相关因素、营养配方的选择、鼻饲/管饲给药、营养制剂的保存等方面。结论建议临床科室在对证据进行应用时,需要评估所在医疗机构的临床环境/条件、医务人员应用证据的促进因素及阻碍因素、患者意愿及偏好等针对性的选择证据。同时,由于最佳证据随着时间的推移不断更新,应用者还持续对证据进行更新,最终通过应用最佳证据,以科学的护理方法解决肠内营养并发腹泻的问题,提升护理质量。

Object To collect evidences of diarrhea during enteral nutrition support in critical ill patients, to provide reference for related departments to reduce the incidence rate of diarrhea during enteral nutrition. Methods With the method of evidence-based nursing, questions of every step of implementing enteral nutrition were put forward. Literatures on enteral nutrition complicated with diarrhea were searched and Johns Hopkins Evidence Practice Model was used to evaluate the quality of literature and the level of evidence. Results Totally 33 pieces of evidence for enteral nutrition complicated with diarrhea, including diarrhea identification,assessment, enteral diarrhea-related factors, nutritional formula selection, nasal feeding/custody administration and preservation of nutritional preparations were collected. Conclusion It is suggested that clinical environment/condition of the medical institution,contributing and obstructive factors, the patient ＇s intention and preference should be assessed before using the evidence. At the same time, updated evidence will benefit the treatment of diarrhea during enteral nutrition and the improvement of nursing quality.