早期肠内营养理念在重症医学教学中的应用探讨

Application of Teaching Concept of Early Enteral Nutrition in Critical Care Medicine

早期肠内营养是改善危重症患者预后的重要措施之一,目前已被多数重症营养指南所推荐。在危重症早期,常合并胃肠功能障碍,可以实施小剂量的肠内营养喂养,即“滋养型喂养”。但是,早期肠内营养实施过程中的评估、时机、目标等问题,仍存在一定程度的认识不足,尤其是基层医院的现状更加不容乐观。因此,强化早期肠内营养理念,规范营养实施流程,仍是重症医学临床教学过程中的重要目标之一。早期肠内营养流程包括营养风险的评估,胃肠功能的评估,启动条件与时机,误吸风险的评估,肠内营养耐受性的评估,营养目标的设定与完成情况等。在临床教学过程中,可根据不同学习对象、不同学习阶段、不同临床场景,采取灵活多变、高效便捷的教学方法,强调营养问题的重要性及突出性,严格执行早期肠内营养流程,规范营养实施步骤,逐步树立早期肠内营养的理念,提高重症患者早期肠内营养的实施比例与完成率。

Early enteral nutrition is one of the important measures to improve the prognosis of critically ill patients.At present,the concept of early enteral nutrition has been recommended by most nutrition guidelines in critical care medicine.In the early stage of critical illness,low-dose enteral nutrition feeding,namely“nourishing feeding”,is recommended.However,there is still a lack of understanding of the evaluation,timing and target in the implementation of early enteral nutrition.Therefore,strengthening the concept and procedure of early enteral nutrition is still one of the important objectives in the clinical teaching of critical care medicine.Early enteral nutrition procedure includes nutrition risk assessment,gastrointestinal function assessment,starting timing,aspiration risk assessment,feeding tolerance assessment,nutrition goal,and so on.In the process of clinical teaching,we can use different teaching methods and different clinical scenes to emphasize the importance and prominence of nutrition problems.Moreover,we should strictly perform the procedure of early enteral nutrition,establish the concept of early enteral nutrition,and then improve the implementation proportion and completion rate of early enteral nutrition gradually in critically ill patients.