腹腔高压患者以腹内压为导向的肠内营养的证据总结

Evidence summary of intra-abdominal pressure-guided enteral nutrition in patients with intra-abdominal hypertension

目的检索并获取腹腔高压患者以腹内压为导向的肠内营养评估及管理的相关证据,旨在为临床医护人员对腹腔高压患者进行肠内营养相关临床决策时提供循证依据。方法系统检索中国知网、万方数据库、中国生物医学文献、UpToDate、PubMed、Cochrane Liberary、BMJ Best Practice等中英文数据以及美国肠外肠内营养学会、苏格兰学院校际指南网等国内外指南网中关于成年人腹腔高压患者以腹内压为导向的肠内营养策略的所有证据,研究类型包括临床决策、系统评价/Meta分析、证据总结、专家共识、指南或与本研究主题密切相关的高质量原始研究。检索时限为建库至2021年11月,根据研究类型选择文献评价工具,由2名经过循证方法学培训的研究者分别独立对纳入的文献进行质量评价,充分考虑临床情境与专家意见,完成证据提取及总结。结果最终纳入13篇文献,包括5篇指南、3篇专家共识、1篇证据总结以及4篇原始研究,汇总得到29条腹腔高压患者以腹内压为向导肠内营养的循证实践证据,包括测量腹内压的时机、腹内压的监测方式、腹腔高压的界定与分级、腹腔压力增高的危险因素、早期启动肠内营养的条件、营养配方的选择、肠内营养的温度设置、肠内营养的速度及调节以及腹腔间隙综合征预防9个方面。结论本研究总结了腹腔高压患者腹内压管理及肠内营养治疗的最佳证据,在风险管理、规范临床实践、保障治疗安全提供循证依据,在证据转化阶段,临床医护人员需全面权衡早期肠内营养的益处与风险,结合临床实际应用场景,针对性整合证据,以便形成适用于腹腔高压患者地规范化早期肠内营养管理方案。

Objective To retrieve and obtain relevant evidence of intra-abdominal pressure-oriented enteral nutrition assessment and management in patients with intra-abdominal hypertension,in order to provide evidence-based evidence for clinical medical staff to make enteral nutrition-related clinical decisions for patients with intra-abdominal hypertension.Methods Systematic retrieval of Chinese National Knowledge Infrastructure,Wanfang,Chinese Biomedical Literature,UpToDate,PubMed,Cochrane Library,BMJ Best Practice and other English data,as well as domestic and foreign guidelines such as American Society for Parenteral and Enteral Nutrition,Scottish Intercollegiate Guidelines Network,etc.All evidence available on the Internet in both Chinese and English on intra-abdominal pressure-guided enteral nutrition strategies in adults with intra-abdominal hypertension,study types including clinical decision-making,systematic reviews/meta-analyses,evidence summaries,expert consensus,guidelines or related to the subject of this study closely related high-quality original research.The retrieval time was from the establishment of the database to November 2021.The literature evaluation tool was selected according to the research type.Two researchers trained in the evidence-based system independently evaluate the quality of the included literature,fully considering the clinical situation and expert opinions,and completed the evidence.Extracted and summarized.Results Totally 13 articles were finally included,including 5 guidelines,3 expert consensuses,1 evidence summary and 4 original studies,and 29 evidence-based practice evidence of enteral nutrition in patients with intra-abdominal hypertension were collected,including the monitoring timing of enteral pressure,the pressure of enteral high pressure and the way of enteral nutrition,the pressure measurement of the abdominal cavity,the setting of abdominal pressure,the temperature conditions for early start of enteral nutrition,the selection of enteral pressure,the temperature setting of enteral nutrition nine aspects such as speed and regulation of internal nutrition and abdominal compartment syndrome prevention.Conclusions This study summarizes the best evidence of intra-abdominal pressure management and enteral nutrition therapy in patients with intra-abdominal hypertension,and provides evidence-based basis for risk management,standardizing clinical practice,and ensuring treatment safety.In the stage of evidence transformation,clinical medical staff need to comprehensively weigh the benefits and risks of early enteral nutrition,and integrate evidence in combination with clinical practical application scenarios,so as to form a standardized early enteral nutrition management plan suitable for patients with intra-abdominal hypertension.