ICU患者基于腹内压分级肠内营养管理的最佳证据总结  

Graded enteral nutrition management based on intra-abdominal pressure for ICU patients:a summary of best evidence

作　　者：王梅梅 王银娥 乔安花 李文放 王振杰 Wang Meimei;Wang Yin’e;Qiao Anhua;Li Wenfang;Wang Zhenjie(Department of Emergency Surgery,Research Institute of Emergency and Critical Care,the First Affiliated Hospital,Bengbu Medical University,Bengbu 233000,Anhui Province,China;Department of Nursing Administration of Shanghai Changzheng Hospital,Shanghai 200000,China;Department of Critical Care Medicine of Shanghai Changzheng Hospital,Shanghai 200000,China)

机构地区：[1]蚌埠医科大学第一附属医院急诊外科,急危重症研究所,安徽蚌埠233000 [2]上海长征医院护理处,上海200000 [3]上海长征医院重症医学科,上海200000

出　　处：《现代临床护理》2025年第1期68-76,共9页Modern Clinical Nursing

基　　金：2022年申康急危重症医学、急诊急救护理关键技术培训基地项目任务书,项目编号为SHDC22022224。

摘　　要：目的检索、评价、整合国内外ICU患者基于腹内压分级肠内营养管理的相关证据,为临床规范管理ICU腹腔高压患者肠内营养提供循证依据。方法按照“6S”模型系统检索中国知网,维普网,中国生物医学数据库,万方,Cochrane Library,医脉通,UpToDate,国际指南协作网,苏格兰校际指南网,PubMed,Ovid,Web of Science,Embase,NICE,美国肠外肠内营养学会、世界腹腔间隔室综合征协会、欧洲危重病学会、欧洲临床营养与代谢学会中关于ICU患者基于腹内压分级肠内营养管理的相关内容,包括指南、临床决策、专家共识、系统评价、证据总结以及与本研究主题密切相关的原始研究,检索时限截至2023年10月31日。结合临床专业判断,对符合质量标准的文献进行证据提取及综合。结果共纳入文献23篇,包括指南4篇、证据总结1篇、系统评价1篇、专家共识4篇、随机对照试验研究6篇、病例对照研究1篇、类实验研究6篇。经严格质量评价、证据提取和汇总,以腹内压分级为主线,最终形成腹腔高压界定及分级、腹内压监测、目标喂养量评估、Ⅰ级腹内压管理、Ⅱ级腹内压管理、Ⅲ级腹内压管理、Ⅳ级腹内压管理7个方面共28条最佳证据。结论本研究总结目前关于ICU患者基于腹内压分级肠内营养管理的最佳证据,为ICU医护人员进行护理实践提供科学有效的临床决策依据,以科学的护理方法来管理ICU腹腔高压患者肠内营养的问题,提升护理质量。Objective To search,evaluate and integrate the evidence on enteral nutrition management based on intra-abdominal pressure(IAP)in ICU patients so as to provide an evidence-based basis for a standardised clinical enteral nutrition management for ICU patients with abdominal hypertension.Methods According to the“6S”model,the systematic searches were conducted on CNKI,VIP,SinoMed,Wanfang,Cochrane Library,Medive,UpToDate,International Guidelines Collaboration,Scottish Intercollegiate Guidelines,PubMed,Ovid,Web of Science,Embase,NICE,American Society for Parenteral Enteral Nutrition,World Association for Parenteral Syndromes,European Society of Critical Care,European Society of Clinical Nutrition and Metabolism on the grading of enteral nutrition based on intra-abdominal pressure classification,including guidelines,clinical decision-making,expert consensus,systematic evaluations,summaries of evidence,and original studies closely related to the topic of this study,with a search timeframe up to 31st October 2023.Evidence was extracted and synthesised from the literature that met the quality criteria,taking into account clinical professional judgement.Results A total of 23 articles were retrieved,including four guidelines,one evidence summary,one systematic evaluation,four expert consensuses,six randomized controlled trials,one case-control study and six quasi-experimental studies.Through strict quality evaluation,evidence extraction and summarisation,seven themes with 28 pieces of best evidence were extracted,with IAP grading as the main topic.The themes included definition and grading of abdominal hypertension,IAP monitoring,assessment of target feeding volume,IAP grades I-IV.Conclusion This study summarises the best evidence on graded enteral nutrition management for ICU patients based on IAP.This evidence provides an effective scientific basis on clinical decision-making for ICU professionals.It aims to manage the enteral nutrition for ICU patients with intra-abdominal hypertension using a scientific nursing method

关 键 词：重症监护室 腹腔高压 腹内压分级 肠内营养 证据总结 

分 类 号：R473.5[医药卫生—护理学]