危重症患者肠内营养支持阻碍因素的现况研究

Barriers to delivery of enteral nutrition among critically ill patients: a cross-sectional study

目的探讨危重症患者肠内营养支持的阻碍因素,为改善临床肠内营养实践提供依据。方法采用便利抽样法,使用汉化版危重症患者肠内营养喂养阻碍量表对上海某三级甲等综合医院125名ICU医护人员进行调查,了解危重症患者肠内营养支持阻碍因素。结果共有119名医护人员完成调查,量表总分(105.7±28.7)分,维度得分由高至低依次是“营养专家支持”“指南推荐和执行策略”“危重症患者照顾者态度和行为”“ICU资源”和“患者肠内营养输注”。此外,医生和护士在阻碍因素的评判上存在一定相似性。结论医护人员对危重症患者肠内营养支持阻碍因素普遍存在且在中等以上影响水平,可通过ICU专职营养师岗位的设立、营养专科护士的培养、肠内营养支持理论的系统培训和重症新技术的获得等,以改善危重症患者肠内营养支持的临床实践。

Objective To investigate the barriers to delivery of enteral nutrition among critically ill patients. Methods The Chinese version of barriers to delivery of enteral nutrition was adapted to investigate the barriers among the doctors and nurses of ICU of a general hospital in Shanghai by using simple sampling. Results Totally 119 doctors and nurses participated in the investigation. The mean score of the whole scale was 105.7 ±28.7. By the mean score, the dimensions were "nutrition expert support", "guideline recommendation and implementation strategy", "caregiver attitude and behavior of critically ill patients", "ICU resources" and "enteral nutrition infusion of patients" in descending order. The doctors and nurses showed similar judgement on barriers to feed critically ill patients. Conclusions Barriers are common and they influence the delivery to the critically ill patients at a medium degree. The obstructing factors of enteral nutrition support in critical patients are common and have medium or above influences. The clinical practice of enteral nutrition support for the critically ill patients can be improved through the establishment of full-time nutritionists for ICU, cultivation of nutrition specialist nurses, systematic training of enteral nutrition support theories and new technologies.