肠内营养相关性腹泻预防及管理的证据审查及影响因素

Evidence for prevention and management of enteral nutrition⁃related diarrhea:evidence review and influencing factors

目的:了解住院病人肠内营养相关性腹泻预防及管理的证据应用现状,并分析阻碍因素和促进因素。方法:于2022年3月—4月选取湖北省某三级甲等医院行肠内营养治疗、护理的102名医护人员及接受肠内营养支持的45例病人作为临床审查对象,进行证据生成和综合,建立审查指标,进行临床基线审查,采用实施性研究综合框架对影响审查指标依从率的阻碍因素和促进因素进行分析。结果:共纳入11条证据,根据最佳证据制定17项审查指标,其中12项审查指标执行率<60%,其主要阻碍因素为缺乏住院病人肠内营养相关性腹泻预防及管理的标准化流程、缺乏肠内营养相关性腹泻评估工具以及医护人员相关知识不足等,主要促进因素为循证实践方案科学可行以及医护人员学习能力和信念感较强等。结论:住院病人肠内营养相关性腹泻预防及管理的证据与临床实践存在较大差距,应针对其阻碍因素和促进因素积极进行临床改进,促进证据的临床转化。

Objective:To investigate the clinical application status of evidence on the prevention and management of enteral nutrition⁃related diarrhea in hospitalized patients,and analyze the obstacles and promoting factors.Methods:A total of 102 medical staff who implemented enteral nutrition treatment and care and 45 patients who received enteral nutrition support in a tertiary grade A hospital in Hubei province were selected as the subjects for evidence review from March to April 2022.Evidence was summarized and reviewed,review indicators were established,and clinical baseline review was completed.The obstacles and promoting factors affected compliance rate of review indicators was analyzed by consolidated framework for implementation research.Results:A total of 11 pieces of evidence were included,and 17 review indicators were formulated based on the best evidence.12 review indicators had implementation rate of<60%.The main obstacles were lack of standardized procedures on prevention and management of enteral nutrition⁃related diarrhea in hospitalized patients,enteral nutrition-related diarrhea assessment tools and knowledge among medical staff and so on.The main promoting factors were scientific feasibility of evidence⁃based practice program,and strong learning ability and sense of belief among medical staff.Conclusions:There is a big gap between the evidence and clinical practice of evidence on the prevention and management of enteral nutrition⁃related diarrhea in hospitalized patients,and clinical improvement should be actively carried out according to its obstacles and promoting factors for promoting the clinical transformation of evidence.