不常规监测胃残余量对持续肠内营养的危重症患者喂养并发症及摄入热量影响的Meta分析  

Feeding effect of not monitoring gastric residual volume in ICU patients receiving continuous enteral feeding: a Meta-analysis

作　　者：余昆容 李梅 王玉娥 赵珠俪 Yu Kunrong;Li Mei;Wang Yu′e;Zhao Zhuli(Pulmonary and Critical Care Medicine Ward, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing100730, China)

机构地区：[1]中国医学科学院北京协和医院呼吸与危重症医学科一病房,100730

出　　处：《中国实用护理杂志》2019年第30期2395-2400,F0003,共7页Chinese Journal of Practical Nursing

摘　　要：目的评价对持续肠内营养的危重症患者不进行常规胃残余量监测对喂养并发症及摄入热量的影响,为临床危重症护理工作提供参考依据。方法计算机检索中国知网(CNKI)、万方数据库、PubMed数据库、Embase数据库、Cochrane library数据库中有关不常规监测胃残余量对危重患者肠内营养喂养并发症及热卡摄入影响的研究,使用RevMan 5.3软件对符合纳入标准的文献进行分析。结果最终纳入5篇合格文献,合计样本量1 000例危重症患者,其中试验组497例,对照组503例。Meta分析结果提示对于持续肠内营养重症患者呕吐发生率的影响常规监测胃残余量组优于不常规监测组[OR=1.35,95%CI(1.02,1.80),Z=2.08,P=0.04],喂养不耐受发生率不常规监测胃残余量组优于常规监测组[OR=0.35,95%CI(0.26,0.46),Z=7.29,P<0.01];对于患者肠内营养目标喂养量与实际喂养量的差值[MD=-0.29,95%CI(-0.47,-0.11),Z=3.23,P=0.001]及每天摄入热量[MD=0.35,95%CI(0.10,0.59),Z=2.75,P=0.006]不常规监测胃残余量组优于常规监测组,而在腹胀发生率[OR=1.24,95%CI(0.76,2.03),Z=0.87,P=0.38]、腹泻发生率[OR=1.14,95%CI(0.78,1.67),Z=0.67,P=0.51]方面2组等效。结论不常规监测胃残余量有利于增加患者的热量摄入,肠内营养并发症中不常规监测胃残余量的患者呕吐率较高,腹胀腹泻率并无显著区别,喂养不耐受发生率较低,喂养效果更好,建议临床避免常规监测胃残余量。Objective To evaluate the feeding effect of not monitoring gastric residual volume in ICU patients receiving continuous enteral feeding,including complications and calorie intake. Methods We searched for relevant studies in China national knowledge internet(CNKI), Wanfang Data, PubMed, Embase, Cochrane library. We included all Randomized controlled trials (RCTs) and pre-post studies related to the feeding effect of not monitoring gastric residual volume in ICU patients receiving continuous enteral feeding. Two researchers independently screened, appraised and extracted data, and meta-analysis was conducted via RevMan 5.3 software. Results 3 RCTs and 2 pre-post studies with 1 000 patients were included. Not monitoring gastric residual volume increase the rate of vomiting [OR=1.35, 95%CI(1.02, 1.80), Z=2.08, P=0.04], decrease the proportion of intolerance to enteral nutrition [OR=0.35, 95%CI(0.26, 0.46), Z=7.29, P<0.01], there were no significant differences in diarrhea [OR=1.14, 95%CI(0.78, 1.67), Z=0.67, P=0.51] and distention[OR=1.24, 95%CI(0.76, 2.03), Z=0.87, P=0.38]. The cumulative calorie deficit between targeted volume and provided volume in not monitoring gastric residual volume group was significantly lower than the control group[MD=-0.29, 95%CI(-0.47,-0.11), Z=3.23, P=0.001], daily provided calorie amount was also significantly higher than the control group [MD=0.35, 95%CI(0.10, 0.59), Z=2.75, P=0.006]. Conclusions Not monitoring gastric residual volume in ICU patients increase calorie intake and have better enteral nutrition provision, decrease the proportion of intolerance to enteral nutrition. Monitoring gastric residual volume should not be taken as a routine task in critical care nursing.

关 键 词：胃残余量 胃潴留 危重症患者 肠内营养 META分析 

分 类 号：R473[医药卫生—护理学]