成人重型颅脑损伤患者肠内营养支持的最佳证据总结  

Summary of the Best Evidence for Enteral Nutrition Support in Adults with Severe Brain Injury

作　　者：郭文超 秦寒枝 滕娇 金魁 孙建[3] 王忠丽 蒋燕 GUO Wenchao;QIN Hanzhi;TENG Jiao;JIN Kui;SUN Jian;WANG Zhongli;JIANG Yan(College of Nursing,Anhui University of Traditional Chinese Medicine,Hefei 230031,China;Department of Nursing,the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital,Hefei 230001,China;Department of EICU,the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital,Hefei 230001,China;Department of Neurosurgery,the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital,Hefei 230001,China)

机构地区：[1]安徽中医药大学护理学院,安徽省合肥市230031 [2]中国科学技术大学附属第一医院安徽省立医院护理部,安徽省合肥市230031 [3]中国科学技术大学附属第一医院安徽省立医院EICU,安徽省合肥市230031 [4]中国科学技术大学附属第一医院安徽省立医院神经外科,安徽省合肥市230031

出　　处：《中国全科医学》2022年第15期1825-1832,共8页Chinese General Practice

基　　金：国家临床重点专科建设项目(国卫办医函[2018]292号)。

摘　　要：背景 肠内营养支持可有效改善重型颅脑损伤患者的营养状况,有利于患者的预后,但国内外相关文献缺乏针对此类患者的系统的营养管理方案,少见肠内营养支持最佳证据总结。目的 检索并总结成人重型颅脑损伤患者肠内营养支持的最佳证据,为临床中该类患者的营养管理提供循证依据。方法 计算机检索BMJ Best Practice、Up To Date、国际指南协作网(GIN)、英国国家卫生与临床优化研究所(NICE)、美国国立指南库(NGC)、加拿大安大略护理学会网站(RNAO)、医脉通、欧洲肠内肠外营养学会(ESPEN)、美国肠内肠外营养学会(ASPEN)、美国重症医学会(SCCM)、欧洲重症医学会(ESICM)、JBI循证卫生保健数据库、Cochrane Library、PubMed、EMBase、CINAHL、中国生物医学文献服务系统(CBM)、中国知网、万方数据知识服务平台、维普网中与成人重型颅脑损伤患者肠内营养相关的所有证据,包括指南、证据总结、最佳实践、专家共识、系统评价及Meta分析,检索时间为2011年4月至2021年4月。采用相应的质量评价标准对纳入的文献进行质量评价,采用JBI循证卫生保健中心证据预分级系统(2014版)和JBI证据推荐级别系统(2014版)对证据进行描述及汇总。结果 共纳入18篇文献,其中临床指南5篇,证据总结3篇,专家共识3篇,系统评价2篇,Meta分析5篇。纳入文献总体质量高,并从营养筛查、营养评估、启动肠内营养时机、能量及蛋白质需求量、肠内营养成分、喂养途径、输注方式及并发症管理8个方面最终形成了25条最佳证据。结论 在给予成人重型颅脑损伤患者肠内营养时,医护人员需要依据最佳证据实施,同时也应结合我国目前的医疗现状及具体治疗目标来制定个体化的肠内营养支持方案,提高营养支持效果,从而改善患者临床结局。Background Enteral nutrition support can effectively improve the nutritional status of patients with severe brain injury,which is beneficial to the prognosis of patients. However,the relevant literature in China and abroad lacks a systematic nutritional management plan for such patients,and there is rare summary of the best evidence for enteral nutrition support. Objective To retrieve and summarize the best evidence of enteral nutrition support in adult patients with severe brain injury,and provide evidence-based evidence for the clinical nutrition management of such patients. Methods All evidence on enteral nutrition in adult patients with severe brain injury was retrieved from databases and websites including BMJ Best Practice,Up To Date,GIN,NICE,NGC,RNAO,Yimaitong,ESPEN,ASPEN,SCCM,ESICM,JBI Library,Cochrane Library,PubMed,EMBase,CINAHL,CBM,CNKI,Wanfang Data,VIP. The retrieved evidence included guidelines,evidence summaries,best practices,expert consensus,systematic reviews and meta-analysis. The retrieval period was from April 2011 to April 2021. Corresponding quality evaluation criteria were used to evaluate the quality of the included literature,and the evidence was described and summarized using the JBI Evidence-based Health Care Center Evidence Pre-grading System(2014 edition) and JBI Evidence Recommendation Rating System(2014 edition). Results A total of 18 articles were included,including 5 clinical guidelines,3 evidence summaries,3 expert consensus,2 systematic reviews,and 5 meta-analysis. Their methodological qualities were rated high overall. Finally 25 pieces of best evidence involving 8 aspects were nutrition screening,nutrition assessment,timing of initiating enteral nutrition,energy and protein requirements,enteral nutrition composition,feeding route,infusion method and complication management. Conclusion When giving enteral nutrition to adult patients with severe brain injury,medical staff need to implement it based on the best evidence. At the same time,an individualized enteral nutrition suppor

关 键 词：颅脑损伤 肠道营养 营养支持 证据总结 循证护理 

分 类 号：R651[医药卫生—外科学]