ICU患者肠内营养支持并发腹泻的循证护理实践  

Evidence-based nursing practice of enteral nutrition support among ICU patients with diarrhea

作　　者：米元元 沈月 郝彬[1] 李锐[1] 黄辉辉 胡蝶 冷秋[1] 马婷婷[1] 喻姣花[3] 黄海燕[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院重症医学科,武汉市420022 [2]湖北省人民医院肿瘤科 [3]华中科技大学同济医学院附属协和医院护理部,武汉市420022

出　　处：《中华护理杂志》2017年第11期1291-1298,共8页Chinese Journal of Nursing

基　　金：湖北省自然科学基金面上项目(2016CFB677)

摘　　要：目的探讨基于最佳证据的ICU患者肠内营养支持并发腹泻的干预方法并评价其效果。方法应用循证护理的方法得出证据并将证据本土化后应用于临床,制订ICU患者实施肠内营养支持并发腹泻的审查标准,规范护理人员的临床行为;采用线上线下的培训方式,对护理人员进行最佳证据的培训,比较应用最佳证据前后ICU患者肠内营养支持期间腹泻的发生率,培训前后护理人员对最佳证据的知晓情况及执行情况。结果最佳证据应用后,ICU患者肠内营养支持并发腹泻发生率由25.58%降至13.89%;ICU护士对腹泻识别与评估、肠内营养支持并发腹泻的相关因素分析、肠内营养配方选择、鼻饲给药等方面有所提高,差异有统计学意义(P<0.05);应用前后在肠内营养输注方式、营养制剂保存方面的比较,差异无统计学意义(P>0.05);ICU护理人员对肠内营养支持并发腹泻最佳证据的执行率大于80%。结论护理人员通过应用最佳证据,以科学的护理方法解决ICU患者肠内营养支持并发腹泻的问题,可提升护理质量。Objective To explore the best intervention based on evidences of enteral nutrition support compli- cated with diarrhea in critically ill patients and evaluate its clinical effects. Methods Evidence was obtained using Evidence-based Nursing,and was implemented in clinical practice after localization,we formulated nursing recom- mendations for regulating nurses＇ clinical practice regarding enteral nutrition support complicated with diarrhea in ICU patients;we conducted multiple online and offline training for nurses. The rate of diarrhea in ICU patients un- dergoing enteral nutrition support before and after using best evidence was compared,and awareness and implemen- tation of best evidence among nurses before and after training were also compared. Results After adapting the best evidence,the rate of enteral nutrition associated diarrhea decreased from 25.58% to 13.89%;ICU nurses＇ diar- rhea identification and evaluation,analysis of influencing factors of enteral nutrition associated diarrhea,selection of enteral nutrition formula,nasal feeding,etc.,were significantly improved （P〈0.05）;there was no significant difference in enteral nutrition infusion,and nutrition preparation and preservation （P〉0.05）;rare of implementation of best evi- dence in ICU nurses was greater than 80%. Conclusion Evidence-based practice can effectively prevent enteral nutrition associated diarrhea in ICU patients. Nurses can solve enteral nutrition associated diarrhea using scientific nursing methods through implementation of best evidence, in order to nursing quality.

关 键 词：肠内营养 营养支持 腹泻 循证护理 重症监护 

分 类 号：R-03[医药卫生] R473