早期肠内营养集束化喂养方案对重症患者营养热卡达标率及喂养不耐受的效果研究

Effect of Early Enteral Nutrition Cluster Feeding Regimen on the Compliance Rate of Nutrition Calorie and Feeding Intolerance in Critically Ill Patients

目的构建基于最佳证据的早期肠内营养(early enteral nutrition,EEN)集束化喂养方案,并评价其效果。方法便利抽样选取2021年1-12月入住上海某三级甲等医院综合ICU并实施肠内营养(enteral nutrition,EN)的重症患者302例为研究对象,采用随机数字表法分为对照组与观察组。对照组(154例)采用EN常规喂养方案,观察组(148例)采用EEN集束化喂养方案。比较两组患者7 d目标热卡达标率、喂养不耐受发生率、喂养中断率及营养相关指标等;同时比较护士通过对该方案的培训对最佳证据的知晓度及执行情况。结果实施EEN集束化喂养方案后,观察组7 d目标热卡达标率(46.7%)高于对照组(29.2%),喂养不耐受及喂养中断率低于对照组,7 d后营养相关指标(血红蛋白、血清前清蛋白、转铁蛋白)均高于对照组,差异均有统计学意义(均P<0.05)。ICU护士对相关证据的掌握程度较方案实施前有所提高,对集束化方案的各项执行率均大于90.0%。结论遵循EEN集束化护理方案,能使ICU重症患者尽早达到目标喂养量,减少喂养不耐受症状,改善患者营养状态,同时提高护士相关证据知晓度及执行率。

Objective To construct a cluster feeding regimen for early enteral nutrition(EEN)based on best evidence and evaluate its effectiveness.Methods By convenience sampling method,302 critically ill patients with enteral nutrition(EN)who were admitted to ICU from January to December 2021 in a tertiary hospital were randomly divided into a control group and an intervention group.The control group(154 patients)received an EN routine feeding regimen.The intervention group(148 patients)received the EEN cluster feeding program.The 7-day compliance rate of nutrition calories,feeding intolerance rate,feeding interruption rate and nutrition related indexes were compared between the two groups.At the same time,the nurses’awareness and implementation of the best evidence through the training of the program were compared.Results After the implementation of EEN cluster feeding program,the 7-day compliance rate of nutrition calories in the intervention group(46.7%)was significantly higher than that in the control group(29.2%).Meanwhile,the rates of feeding intolerance and feeding interruption were lower than those of the control group.After 7 days,the nutrition-related indexes(hemoglobin,serum pre-albumin and transferrin)in intervention group were higher than those in control group(all P<0.05).ICU nurses’knowledge of relevant evidence had been improved compared with that before the implementation of the program,and the implementation rate of the cluster program was more than 90.0%.Conclusions Early EEN cluster feeding regimen can achieve the target feeding amount as early as possible in critically ill patients,reduce feeding intolerance symptoms and improve the nutritional status of patients.