肠内营养支持病人误吸的预防与管理最佳证据总结

Best evidence summary for the prevention and management of aspiration during enteral nutrition support therapy in patients

目的:检索分析并总结肠内营养支持病人误吸的预防和管理最佳证据。方法:使用PIPOST模式来确定问题,按照"6S证据模型",检索以误吸、肠内营养为主题的相关文献,在文献质量评价后进行证据级别判定。结果:共纳入文献15篇,其中临床决策3篇、证据总结3篇、指南3篇、系统评价4篇、专家共识1篇以及队列研究1篇。最终总结出最佳证据16条,主要包括评估、团队管理、确定管道位置、喂养速度、喂养途径、胃残留量检测、体位管理、气道管理和口腔护理9个方面。结论:总结出的证据在临床应用的过程中需要将病人的意愿与临床环境相结合,将总结出的最佳证据应用于肠内营养病人误吸的预防与管理中,有利于降低误吸发生率、提升护理质量。

Objective:To retrieve,analyze and summarize the best evidence for the prevention and management of aspiration during enteral nutrition support therapy in patients.Methods:The problem was determined by the PIPOST model.The relevant literatures on the subject of aspiration and enteral nutrition were searched according to the"6S"evidence model.The gradings of evidence was judged after the quality of the literature was evaluated.Results:A total of 15 articles were retrieved,including 3 clinical decisions,3 evidence summaries,3 guidelines,4 systematic reviews,1 expert consensus,and 1 cohort study.Finally,the 16 items of best evidences were summarized,which mainly included such 9 aspects of assessment,team management,determination of pipe position,feeding speed,feeding route,monitoring of gastric residue detection,posture management,airway management and oral care.Conclusions:In the process of clinical application,the summarized evidence needs to be combined with the patient′s preferences and clinical settings.The summarized best evidence should be applied to the prevention and management of aspiration during enteral nutrition support therapy in patients,which is beneficial to reduce the incidence of aspiration and improve the quality of care.