摘要
目的通过系统评价再评价对ICU行肠内营养支持护理及患者是否需要进行胃残留量监测及合理的阈值设置进行探讨,为护理人员临床决策提供参考。方法计算机检索Cochrane Library、EMBASE、PubMed、Web of Science、中文期刊全文数据库、万方数据知识服务平台数据库,检索时间为建库至2018年4月,检索ICU行肠内营养支持患者胃残留量监测的相关系统评价和Meta分析,采用AMSTAR工具评价纳入研究的方法学质量,采用GRADE系统对结局指标进行质量评价。结果共纳入7篇系统评价/Meta分析,文献质量整体不高。是否监测胃残留量对于ICU患者肠内营养并发症、ICU住院时间及ICU患者死亡率等并无影响;不常规监测胃残留量,患者的喂养不耐受及肠内营养中断减少;高胃残留量阈值(胃残留量阈值≥250 mL与胃残留量阈值<250 m L比较)可以明显增加肠内营养摄入量。结论纳入研究的整体质量不高,结局指标的证据以低质量为主,ICU行肠内营养支持监测胃残留量的必要性不大,但合理的胃残留量阈值设置会使患者获益。受纳入研究的数量及质量限制,尚需更高质量的研究证实该结论的可靠性。
Objective To overview the systematic reviews/Meta-analysis of nursing of enteral nutrition(EN) support in ICU, to explore whether it is necessary to carry out the monitoring of gastric residual volume(GRV), and to provide reference for clinical decisionmaking of nursing staff. Methods Cochrane Library, EMBASE, PubMed, Web of Science, CNKI, and Wanfang Data were searched to collect SRs/MAs about GRV monitoring in ICU patients from the inception to April 2018, and the related systematic evaluation and Meta-analysis of GRV monitoring in EN support patients were searched. AMSTAR was used to evaluate the methodological quality of the included studies and outcome indicators were evaluated with the GRADE system. Results Seven systematic reviews were included in the Meta-analysis, and the overall quality of the included study was not high. Whether to monitor GRV or not exerted no effect on EN complications, ICU time and ICU mortality. Without routine GRV monitoring, patients ’ feeding intolerance and EN interruption were reduced. High GRV threshold can significantly increase EN intake. Conclusion The overall quality of the included studies is low, and it is not necessary to monitor GRV for patients with EN in ICU, but reasonable GRV threshold setting will benefit the patients. Due to the limited quantity and quality of the included studies, high quality studies are needed to confirm the reliability of the conclusion.
作者
卜凡莉
梁枫
王珂
黄骞
彭南海
BU Fan-li;LIANG Feng;WANG Ke;HUANG Qian;PENG Nan-hai(Medical School of Nanjing University,Nanjing 210092,China;Research Institute of General Surgery,Jinling Hospital of PLA,Nanjing 210002,China)
出处
《护理学报》
2019年第5期25-29,共5页
Journal of Nursing（China）
基金
国家自然科学基金面上项目(81670508)
关键词
重症监护室
肠内营养
胃残留量
系统评价再评价
Intensive Care Unit
enteral nutrition
gastric residual volume
overviews of reviews
