河北省多家重症医学科医护人员营养治疗认知现状及分析

An Investigation on current practice of nutrition therapy for critically ill patients in Hebei ICUs

目的:调查河北省多家医院重症医学科医护人员营养治疗认知现状,寻找与指南之间的差距,规范重症病人营养治疗。方法:通过填写《河北省多中心重症医护营养调查问卷》,调查结束后统计分析结果。结果:河北省24家医院重症医学科共640名医护人员参与调查,39.5%医护人员未采用重症病人营养风险(NUTRIC)评分或急性胃肠功能损伤(AGI)分级进行胃肠功能评估,近80%医护人员能够在入科后48 h内启动肠内营养(EN),42.2%医护首选短肽类EN制剂,绝大多数(95.5%)医护人员常规监测血糖水平,45.9%医护人员会在3 d内启动肠外营养(PN),EN耐受较差时,下调EN泵注速及加用促胃肠动力药物各占1/3,一半以上的科室有自己的营养预案,大部分(81.6%)医护人员仍根据胃残余量监测胃肠功能,仅少数(4.2%)医护人员应用床旁超声,66.9%医护人员不常规补充蛋白,11.2%医护人员认为应用升压药就不给予EN,应激性溃疡的重症病人早期加用EN的医护人员仅8.5%。结论:河北省多家医院重症医学科医护人员对于营养治疗的认识与指南比较仍存在差距,今后需加强学习交流,制定适合于本科室的喂养流程,优化重症病人营养治疗。

Objective:To conduct a multicenter survey to evaluate the cognitive status of nutrition treatment in the intensive care unit in Hebei Province.To find the gap between the guidelines and the practice,standardize nutrition therapy.Methods:To fill in"the nutrition survey of multicenter critical care in Hebei Province",and analysis the data after the survey.Results:640 medical and nursing staff from 24 ICUs filled in this survey.39.5%of questionnaires did not use the NUTRIC or acute gastrointestinal function injury score for nutritional evaluation.80%questionnaires preferred early enteral nutrition(within 48 hours after admission),and 45.9%questionnaires started parenteral nutrition within 3 days.42.2%of questionnaires preferred short peptide enteral nutrition.The majority of questionnaires(95.5%)routinely monitored blood glucose.1/3 of questionnaires would reduce the injection speed of enteral nutrition,and 1/3 of them would add gastrointestinal motility drugs while enteral nutrition intolerance occurred in critically ill patients.More than half of ICUs have their own nutrition protocol.Most questionnaires(81.6%)still monitored the gastrointestinal function depending on the gastric residual volume,and only a few(4.2%)staff use bedside ultrasound.66.9%of staff did not supplement protein.11.2%of doctors would stop enteral nutrition while using vasopressor,and only 8.5%of doctors would add enteral nutrition in severe patients with stress ulcer.Conclusion:There was still a gap between the practice of nutrition support and the guidance in ICUs in Hebei.In the future,we need to strengthen the learning,develop the feeding protocol,and optimize the nutrition treatment of the critical patients.