基于循证的集束化护理方案在25例ECMO患者肠内营养护理中的应用效果

Effect of Evidence-Based Clustered Nursing Protocol in 25 ECMO Patients with Enteral Tube Feedings

摘要: 目的：探讨基于循证的集束化护理方案在25例ECMO患者肠内营养的应用效果。方法：运用循证护理学的方法，围绕ECMO患者营养护理中存在的临床临床问题进行文献检索，并对文献进行质量方法学评价，最终形成临床证据，采用澳大利亚JBI中心证据级别和推荐系统(2014版)对汇总的证据进行级别划分，并围绕证据的FMEA属性，开展专家函询，形成集束化护理方案，应用于我科25例ECMO患者。结果：25例患者(12例采用VA ECMO，13例采用VV ECMO)，平均ECMO时长为17.5天。4例采用鼻胃管喂养，21例采用鼻肠管喂养。2例患者出现胃残余量GRV > 500 ml/24h，1例患者出现腹泻，3例患者腹内压IAP > 15 mmHg，无一例出现呕吐及消化道出血。17例4 d喂养达标，4 d热卡达标率68%，23例7 d喂养达标，7 d热卡达标率92%。结论：基于循证的肠内营养集束化护理方案，可以提高ECMO患者的营养喂养达标率，且降低肠内营养不耐受的发生。

Abstract: Objective: To explore the effect of the evidence-based clustered nursing protocol on enteral nutrition in 25 patients with ECMO. Methods: Using evidence-based nursing methods, literature retrieval was conducted around clinical problems in ECMO patient nutritional care, and the literature was evaluated on quality methodology, and clinical evidence was finally formed. The evidence level and recommendation system of the Australian JBI Center (2014 Version) classify the collected evidence, and focus on the FMEA attributes of the evidence, carry out expert consultation, form a clustered care plan, and apply it to 25 ECMO patients in our department. Results: In 25 patients (12 cases used VA ECMO, 13 cases used VV ECMO), the average ECMO duration was 17.5 days. 4 cases were fed by nasogastric tube and 21 cases were fed by naso-intestinal tube. 2 patients had gastric residual volume GRV > 500 ml/24h, 1 patient had diarrhea, 3 patients had intra-abdominal pressure IAP > 15 mmHg, none of them had vomiting and gastrointestinal bleeding. Seventeen cases met the 4 d feeding standard, the 4 d calorie compliance rate was 68%, and 23 cases met the 7 d feeding standard, and the 7 d calorie compliance rate was 92%. Conclusion: Evidence-based enteral nutrition clustering nursing protocol can improve the nutritional feeding rate of ECMO patients and reduce the occurrence of enteral nutrition intolerance.