重症患者肠内喂养障碍的现状及其影响因素

Current status and influencing factors of barriers to enteral feeding of critically ill patients

目的从护士角度探讨重症监护室患者肠内营养喂养障碍现状,分析其影响因素。方法本研究为横断面调查。采用便利抽样法,选取青海省第五人民医院、西宁市第二人民医院、青海省人民医院、西宁市第一人民医院、青海省中医院2018年6月至2019年6月180例重症加强护理病房(ICU)护士为研究对象。采用问卷调查收集ICU患者肠内喂养障碍问卷评估肠内喂养障碍现状和多元线性回归分析确定ICU患者肠内喂养障碍影响因素。结果ICU护士肠内喂养障碍问卷总分为(61.13±12.76)分,3个维度得分为(3.21±0.43)分。3个维度得分从高到低为患者肠内营养供给(3.55±0.07)分、ICU医护人员态度和行为(3.05±0.48)分以及ICU资源(2.82±0.05)分。19个条目中得分最高的4个条目分别为:没有按时给予肠内营养医嘱(3.97±1.40)分,因腹泻而暂停肠内营养(3.66±1.27)分,饮食教育时间不足(3.65±1.38)分,确定营养管正确位置所需时间(3.56±1.23)分。肠内营养相关培训频率(P<0.001),是否有专职ICU营养师(P=0.002)和医院等级(P=0.021)、肠内营养手册(P=0.043)和护士职称(P=0.001)是ICU患者肠内喂养障碍影响因素。结论ICU患者肠内喂养情况受多因素影响。因此,医院部门应加强护士标准化和系统化给予肠内喂养的培训,向ICU提供专职营养师护士,合理配置资源。此外,从循证指南的角度制订肠内喂养方案并发挥患者主观能动性。

Objective To explore the status of intestinal feeding disorders in intensive care unit nurses from five hospitals,and to analyze the influencing factors.Methods This study was a cross⁃sectional survey.Using convenient sampling method,180 ICU nurses from June 2016 to June 2019 in five hospitals were selected as subjects.The general data characteristics of nurses were collected using enteral feeding management questionnaires.The ICU patients with intestinal feeding disorder questionnaire were used to evaluate the status of intestinal feeding disorders.Univariate analysis was used to determine the effect of general characteristics of nurses on intestinal feeding disorders.Multiple linear regression analysis was used to determine the influencing factors of intestinal feeding disorders in ICU patients.Results The total score of the ICU nurses′intestinal feeding disorder questionnaire was(61.13±12.76)points,and the scores of the three dimensions were(3.21±0.43)points.The three dimensions scored from high to low for patient EN supply(3.55±0.07)points,ICU care staff attitude and behavior(3.05±0.48)points and ICU resources(2.82±0.05)points.The four highest scores among the 19 items were:doctors prescribed a delay in starting the enteral nutrition(3.97±1.40)points,suspended enteral nutrition due to diarrhea(3.66±1.27)points,insufficient time for education and training how to best feed patients(3.65±1.38)points,waiting for the doctor/radiologist to read the chest X⁃ray to determine the correct position of the nutrition tube(3.56±1.23)points.EN⁃related training frequency(P<0.001),full⁃time ICU nutritionist(P=0.002)and hospital grade(P=0.021),EN manual(P=0.043)and professional title(P=0.001)are the effects of enteral feeding disorders in ICU patients factor.Conclusion Intestinal feeding disorders in ICU patients are affected by multiple factors.Therefore,the hospital department should strengthen nurse standardized and systematic feeding training,provide full⁃time nutritionist to ICU,and rationally allocate resources.In addition,an enteral feeding program is developed from the perspective of an evidence⁃based guideline and the patient′s subjective initiative is exerted.