危重症患者肠内营养并发胃潴留护理的最佳证据总结

Summary of best evidence for the management of enteral nutrition with gastric retention in critically ill patients

目的检索、评价并总结国内外关于危重症患者肠内营养并发胃潴留护理的最佳证据,为临床护理人员进行危重症患者肠内营养并发胃潴留护理提供参考依据。方法系统检索UpToDate、BMJ Best Practice、英国国家卫生与临床优化研究所网站、国际指南协作网、加拿大安大略医学会网站、苏格兰院际间指南网、WHO网站、中国医脉通网站、相关营养协会网站及乔安娜布里格斯研究所循证卫生保健中心数据库、Cochrane Library、PubMed、Embase、Web of Science、CINAHL、中国知网、万方数据库、中国生物医学文献数据库、维普数据库等关于危重症患者肠内营养并发胃潴留管理的证据,包括临床决策、指南、系统评价及专家共识等,检索时限为建库至2022年11月。由2名研究者独立进行文献质量评价和资料提取。结果共纳入18篇文献,包括3篇指南、4篇专家共识、4篇系统评价、5篇随机对照试验、1篇类实验研究、1篇最佳证据总结。总结出18条最佳证据,包括胃潴留识别、肠内营养管理、监测管理、阈值判定和非药物治疗5个方面。结论该研究为护理人员进行危重症患者肠内营养并发胃潴留管理提供循证证据,有助于降低危重症患者胃潴留发生率。

Objective To retrieve,evaluate and summarize the best evidence from home and abroad on the management of enteral nutrition complicating gastric retention in critically ill patients,and to provide a reference basis for clinical nursing staff to manage enteral nutrition complicating gastric retention in critically ill patients.Methods We searched websites and databases,including UpToDate,BMJ Best Practice,National Institute for Health and Clinical Excellence,Guidelines International Network,Registered Nurses Association of Ontario,Scottish Intercollegiate Guidelines Network,JBI,World Health Organization,Yimaitong guide network,Cochrane Library,PubMed,Embase,Web of Science,Sinomed,CNKI,Nutrition Society website,CINAHL(EBSCO),Wanfang Database,and collected relevant clinical decisions,guidelines,evidence summaries,expert consensuses and systematic reviews.2 researchers independently assessed methodological quality of included papers and extracted data.Results A total of 18 publications were included,including 3 guidelines,4 expert consensuses,4 systematic reviews,5 randomized controlled trials,1 quasi-experimental study,and 1 best evidence summary.18 pieces of the best evidence were summarized in 5 areas,including identification of gastric retention,management of enteral nutrition,management of monitoring,management of threshold determination,and management of treatment.Conclusion This study provides evidence-based evidence for nursing staff to manage enteral nutrition in critically ill patients with concomitant gastric retention,which can help reduce the incidence of gastric retention in critically ill patients.