重症鼻饲患者喂养不耐受症状管理的证据总结

摘要

Objective: To retrieve, analyze and summarize the best available evidence on symptom management of Feeding Intolerance among critically ill patients with nasogastric tube feeding. Methods: To collect literatures involving guideline, evidence summary, best practice information, recommended practice and systematic review, we searched the BMJ best practice, PubMed, Cochrane Library, Ovid, EMbase, CNKI, WanFang Data, National Guideline Clearinghouse, The National Institute for Health and Care Excellence, Registered Nurses' Association of Ontario, American Society for Parenteral and Enteral Nutrition, European Society for Clinical Nutrition and Metabolism, et a1. Results: We eventually recruited 23 references, including 4 clinical practice guideline, 1 evidence summary, 8 systematic review, 5 randomized controlled trials, 2 quasi-experimental studies, 2 cross-sectional studies and 1 diagnostic test accuracy study. After rigid appraisal, we fnally concluded 26 items of best evidence concerning Feeding Intolerance assessment, body position, nutrition formula, feeding method, monitoring gastric residual volume and management of common symptoms. Conclusion: Clinical nurses should use evidence-based symptom management scheme to deal with Feeding Intolerance, which can provide security for critically ill patients with nasogastric tube feeding.%目的:检索、评价和总结重症鼻饲患者喂养不耐受症状管理的证据.方法:计算机检索 BMJ 最佳临床实践、PubMed、Cochrane Library、Ovid、EMbase、中国知网、万方数据库和 NGC、NICE、RNAO、 ASPEN、ESPEN 等国内外指南网、数据库及营养学会官方网站涉及重症鼻饲患者喂养不耐受评估、预防及护理的文献,包括临床实践指南、证据总结、最佳实践信息册、推荐实践及系统评价,并通过追溯以上证据的参考文献纳入支持相关证据的原始研究,检索时限截至 2018 年 3 月.结果 :共纳入 23 篇文献,其中 4 篇临床实践指南、1篇证据总结、8 篇系统评价、5 项随机对照试验、2 项类实验性研究、2 项横断面研究和 1 项诊断性试验.经严格质量评价、证据提取和汇总,最终形成 26 条推荐意见,内容涵盖喂养不耐受的识别与评估、体位管理、营养配方、鼻饲喂养方式、胃残余量监测及常见症状处理等 6 个方面.结论 :临床护士应使用基于循证依据的喂养不耐受管理方案,以保障重症患者鼻饲安全.