成人重症患者经鼻肠管喂养的护理实践总结

Summary of nursing practice of adult critically ill patients with naso-intestinal tube feeding

目的检索、评价和总结重症患者经鼻肠管喂养的护理临床实践证据,为纠正喂养不耐受、营养不达标提供护理依据。方法按照"6S"证据模型,检索2015年1月31日—2019年9月30日加拿大安大略护理学会、Cochrane Library、英国国家卫生与临床优化研究所、苏格兰学院间指南网、国际指南图书馆、医脉通、PubMed、CINAHL、Embase、UpToDate、乔安娜布里格斯研究所(JBI)循证卫生保健中心数据库、CNKI、万方数据库、维普数据库等涉及重症患者经鼻肠管喂养护理的相关证据,包括指南、专家共识、最佳实践、系统评价、证据总结及原始研究。由2名研究者对纳入的文献质量进行评价,并提取和汇总符合质量标准的文献。结果共纳入24篇文献,其中,2篇指南来源于美国重症医学会和美国肠外肠内营养学会、欧洲肠外肠内营养学会,3篇专家共识,1篇系统评价,4篇证据总结,10篇RCT研究,3篇类实验研究,1篇诊断性试验研究。总结临床适应性证据24条,涉及10个方面内容,即鼻肠管置入指征、导管材质、置入体位、置入方式、确认方法、喂养方法、固定、不耐受、导管堵塞、留置时限等。结论本研究为重症患者经鼻肠管喂养提供了管理流程与循证证据,有利于促进护理人员安全实践与深入的研究。

Objective To retrieve,evaluate and summarize the clinical practice evidence of nursing care for critically ill patients with naso-intestinal tube feeding,so as provide a basis for correcting feeding intolerance and nutritional substandard.Methods According to the"6S"evidence model,evidence on nursing care for critically ill patients with naso-intestinal tube feeding was retrieved in Registered Nurses'Association of Ontario,Cochrane Library,National Institute for Health and Clinical Excellence,Scottish Intercollegiate Guidelines Network,Guidelines International Network,Medive,PubMed,CINAHL,Embase,UpToDate,Joanna Briggs Institute Evidence-based Practice Database,China National Knowledge Infrastructure(CNKI),WanFang Data,VIP database from January 31,2015 to September 30,2019.Evidence included guidelines,expert consensus,best practices,systematic reviews,evidence summary,and original research.Two researchers evaluated the quality of the included literature,extracted and summarized literature that met the quality standards.Results A total of 24 articles were included,of which 2 guidelines were derived from the American Society of Critical Care Medicine and the American Society of Parenteral Enteral Nutrition,and the European Society of Parenteral Enteral Nutrition,3 expert consensus,1 systematic review,4 evidence summaries,10 randomized controlled studies,3 quasi experiments,and 1 diagnostic test.This study summarized 24 evidences of clinical suitability,involving 10 aspects,namely,naso-intestinal tube placement indications,catheter material,placement position,placement method,confirmation method,feeding method,fixation,intolerance,catheter blockage and indwelling time limit.Conclusions This study provides a management process and evidence-based evidence for critically ill patients with naso-intestinal tube feeding,which is conducive to promoting safe practice and in-depth research for the nursing staff.