重症患者肠内营养高血糖管理的最佳证据总结

Summary of best evidence for hyperglycemia management in ICU enteral nutrition patients

目的检索、评价和整合重症患者肠内营养高血糖管理的相关证据,总结最佳证据。方法计算机检索欧洲,肠外肠内营养学会网、美国肠外肠内营养学会网、澳大利亚乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健中心数据库、Cochrane Library、OVID循证数据库、UpToDate、PubMed、Embase CINAHL、万方数据库、维普数据库、中国知网及中国生物医学文献数据库中关于重症患者肠内营养高血糖管理相关的临床实践指南、系统评价、原始研究等。采用澳大利亚JBI循证卫生保健中心的文献评价标准和证据分级系统对文献进行质量评价及证据级别评定。结果共纳入13篇文献,从营养筛查与评估、肠内营养实施途径及制剂选择、肠内营养泵的使用及输注速度的控制、血糖监测、高血糖管理5个方面汇总19条最佳证据。结论建议临床科室在应用证据时,综合评估所在医疗机构环境及政策、证据应用的促进及障碍因素等,实施多学科合作的肠内营养患者血糖管理模式、规范肠内营养及血糖临床实践、加强医护人员培训及沟通协作,使患者能安全平稳降糖,改善营养状况及生存质量。

Objective To search,evaluate,and integrate evidence on hyperglycemia management in ICU enteral nutrition patients and summarize the best evidence. Methods We searched European Society for Parenteral and Enteral Nutrition Network,American Society for Parenteral and Enteral Nutrition Network,Joanna Briggs Institute(JBI) Evidence-based Health Care Database,Cochrane Library,OVID Evidence-Based Database,Up To Date,Pub Med,Embase,CINAHL,Wanfang Database,VIP Chinese Scientific and Technical Journal Database,CNKI and Sino Med Database for clinical practice guidelines,systematic review,original studies and other evidence. The literature quality and evidence level were evaluated using the literature evaluation criteria and evidence grading system of Australia JBI Evidence-based Health Care Center. Results A total of 13 literatures were included,and 19 best evidences were collected from 5 aspects:nutrition screening and evaluation,routes and formulation selection of enteral nutrition,use of enteral nutrition pump and infusion speed control,blood glucose monitoring,and hyperglycemia management. Conclusion It is suggested that clinical departments should comprehensively evaluate the environment and policies of medical institutions,as well as the promotion and obstacle factors of evidence application when applying evidence. And the clinical departments should implement multidisciplinary cooperation of blood glucose management model in enteral nutrition patients,standardize enteral nutrition and blood glucose clinical practice,strengthen the training and communication for collaboration of medical staff,so as to reduce patients’ glucose safely and stably,improve nutritional status and quality of life.