行体外膜肺氧合治疗联合俯卧位通气重症肺炎患者的个体化肠内营养支持护理1例

Individualized enteral nutrition support nursing for the patient with severe pneumonia who underwent extracorporeal membrane oxygenation with prone position ventilation: a case report

目的总结1例行体外膜肺氧合治疗联合俯卧位通气重症肺炎患者的肠内营养支持的护理经验。方法对2020年11月8日中南大学湘雅医院收治的1例行体外膜肺氧合治疗联合俯卧位通气重症肺炎患者进行病情评估,制订个体化营养支持方案,实施早期营养干预,选择合适喂养途径,实施过程中进行耐受性的评估、肠内营养相关性并发症的护理。结果经过精心治疗和护理,患者病情好转,转出ICU继续治疗。结论针对重症肺炎患者体外膜肺氧合开始俯卧位时选择幽门后喂养以减少误吸;实施早期滋养性营养,保护肠道黏膜;采用超声监测胃窦运动指数指导患者的肠内营养实施;实施营养过程中定期评估喂养耐受性;根据腹内压结合喂养耐受情况调整肠内营养的策略与实施,同时进行肠内营养并发症的预防及护理。

Objective To summarize the nursing experience of enteral nutritionin a patient with severe pneumonia who received extracorporeal membrane oxygenation combined with prone ventilation.Methods A patient with severe pneumonia who underwent extracorporeal membrane oxygenation combined with prone ventilation from Xiangya Hospital of Central South University on November 8,2020 was given individualized nutrition support program.The patient′s condition was evaluated,individual nutrition support plan was formulated,early nutrition was implemented,appropriate feeding route was selected,tolerance was evaluated during the implementation process,and enteral nutrition-related complications were nursing.Results After careful treatment and nursing,the patient′s condition was improved and was transferred out of ICU for continued treatment.Conclusions For this kind of patients with severe pneumonia who underwent extracorporeal membrane oxygenation combined with prone ventilation to choose the pyloric feeding to reduce aspiration.Early nourishing nutrition to protect the intestinal mucosa;ultrasonic monitoring of antral motility index was used to guide the implementation of enteral nutrition.Regular evaluation of feeding tolerance during nutrition implementation,the strategy and implementation of enteral nutrition were adjusted according to the intra-abdominal pressure combined with feeding tolerance,and the prevention and nursing of enteral nutrition complications were carried out at the same time.