儿童俯卧位通气肠内营养管理的最佳证据总结

Summary of best evidence for enteral nutrition management in children with prone position ventilation

目的检索、评价和整合儿童俯卧位通气肠内营养管理的最佳证据,为构建儿童俯卧位通气肠内营养管理临床护理实践方案提供依据。方法计算机检索UpToDate、BMJ Best Practice、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、Cochrane Library、CINAHL、PubMed、Web of Science、中国知网、万方数据库、中华医学期刊全文数据库、中国生物医学文献数据库、医脉通、国际指南协作网、英国国家卫生与临床优化研究所网站、欧洲肠内肠外营养协会网站、美国肠内肠外营养学会网站、英国饮食协会网站中关于儿童俯卧位通气肠内营养管理的相关证据,包括临床决策、指南、专家共识、系统评价及原始研究等。检索时限均为数据库建立至2023年6月30日。由2名研究员独立筛选文献,对符合质量标准的文献进行证据提取和总结。结果共纳入17篇文献,包括临床决策3篇、指南7篇、专家共识3篇、系统评价2篇、横断面研究1篇、队列研究1篇。总结出俯卧位操作前准备、操作后整理、俯卧位肠内营养重启时机、俯卧后体位管理、喂养方式选择、喂养不耐受管理及预防误吸管理7个主题26条证据。结论儿童俯卧位通气肠内营养管理的最佳证据内容覆盖俯卧位通气患儿肠内营养管理全流程,指导性及可操作性强,可为儿童俯卧位通气肠内营养管理提供依据。医护人员针对不同年龄段儿童特点进一步细化循证护理实践方案,规范儿童俯卧位通气肠内营养操作流程,保证目标喂养量,减少并发症的发生。

ObjectiveTo retrieve,evaluate,and integrate the best evidence for enteral nutrition management in children with prone position ventilation,providing a basis for constructing clinical nursing practice programs for enteral nutrition management in children with prone position ventilation.MethodsEvidence on the management of enteral nutrition in children with prone position ventilation,including clinical decisions,guidelines,expert consensus,systematic reviews,and original studies,was electronically retrieved on UpToDate,BMJ Best Practice,Joanna Briggs Institute Evidence-Based Health Care Center Database in Australia,Cochrane Library,CINAHL,PubMed,Web of Science,China National Knowledge Infrastructure,WanFang Data,Chinese Medical Journal Full-text Database,China Biology Medicine disc,Medlive,Guidelines International Network,National Institute for Health and Clinical Excellence,European Society for Parenteral and Enteral Nutrition,American Society for Parenteral and Enteral Nutrition and British Dietetic Association.The search period was from the establishment of the database until June 30,2023.Two researchers independently screened literature,and extracted and summarized evidence from literature that met quality standards.ResultsA total of 17 articles were included,including three clinical decisions,7 guidelines,three expert consensus,two systematic reviews,one cross-sectional study,and one cohort study.Twenty-six pieces of evidence were summarized from 7 themes of preparation before prone position operation,post operation organization,timing of enteral nutrition restart in prone position,management of prone position,selection of feeding methods,management of feeding intolerance,and prevention of aspiration.ConclusionsThe best evidence for enteral nutrition management in children with prone position ventilation covers the entire process of enteral nutrition management in prone position children,with strong guidance and operability,which can provide a basis for enteral nutrition management in children with prone position ventilation.Medical and nursing staff should further refine evidence-based nursing practice programs based on the characteristics of children of different age groups,standardize the operation process of enteral nutrition in children with prone position ventilation,ensure the target feeding amount,and reduce the occurrence of complications.