对ICU行肠内营养支持患者胃残留量监测相关系统评价的再评价

doi:10.16460/j.issn1008-9969.2019.05.025

摘要/Abstract

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 mL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。

关键词: 重症监护室, 肠内营养, 胃残留量, 系统评价再评价

Abstract: 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 decision-making 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.

Key words: Intensive Care Unit, enteral nutrition, gastric residual volume, overviews of reviews

中图分类号:

R151

卜凡莉, 梁枫, 王珂, 黄骞, 彭南海. 对ICU行肠内营养支持患者胃残留量监测相关系统评价的再评价[J]. 护理学报, 2019, 26(5): 25-29.

BU Fan-li, LIANG Feng, WANG Ke, HUANG Qian, PENG Nan-hai. Overviews of Reviews on Gastric Residual Volume Monitoring in ICU Patients with Enteral Nutrition Support[J]. Journal of Nursing, 2019, 26(5): 25-29.

参考文献

[1] Tian F, Heighes P T, Allingstrup M J.Early Enteral Nutrition Provided With in 24 Hours of ICU Admission: A Meta-analysis of Randomized Controlled Trials[J]. Crit Care Med, 2018, 46(7):1049-1056. DOI:10.1097/CCM.0000000000003152.
[2] Reitnam Blaser A, Starkopf L, Deane A M, et al.Comparison of Different Definitions of Feeding Intolerance: A Retrospective Observational Study[J]. Clin Nutr, 2015,34(5):956-961. DOI:10.1016/j.clnu.2014.10.006.
[3] 周田田,王保荣,朱小芳,等.ICU脓毒症患者肠内营养喂养不耐受的相关因素分析[J].护理学报, 2017,24(16):6-9. DOI:10.16460/j.issn1008-9969.2017.16.006.
[4] McClave S A, Snider H L, Lowen C C, et al.Use of Residual Volume as a Marker for Enteral Feeding Intolerance: Prospective Blinded Comparison with Physical Examination and Radiographic Findings[J].JPEN J Parenter Enteral Nutr,1992,16(2):99-105.
[5] Rice T W.Gastric Residual Volume: End of an Era[J]. JAMA, 2013,309(3):283-284. DOI:10.1001/jama.2012.216616.
[6] McClave S A,Taylor B E,Martindale R G,et al.Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine(SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN)[J]. JPEN J Parenter EnteralNutr,2016,40(2):159-211.DOI:10.1177/0148607115621863.
[7] Hunt H, Pollock A, Campbell P, et al.An Introduction to Overviews of Reviews: Planning A Relevant Research Question and Objective for an Overview[J]. Syst Rev, 2018, 7(1):39-48. DOI:10.1186/s13643-018-0695-8.
[8] Pollock M, Fernandes R M.Evaluation of AMSTAR to Assess the Methodological Quality of Systematic Reviews in Overviews of Reviews of Healthcare Interventions[J]. BMC Med Res Methodol,2017, 17(1):48-60.DOI:10.1186/s12874-017-0325-5.
[9] 袁金秋,刘雅莉,杨克虎,等.系统评价再评价纳入研究的质量评价方法调查[J].中国循证医学杂志,2012,12(2):238-242. DOI:10.3969/j.issn.1672-2531.2012.02.018.
[10] 王濯,沈梅芬.监测胃残余量在危重症患者肠内营养中应用效果的系统评价[J].护士进修杂志,2016,31(5):406-409. DOI:10.16821/j.cnki.hsjx.2016.05.009.
[11] 周松,王建宁,查丽玲,等.不监测胃残留量对ICU行肠内营养患者影响的系统评价[J].护理学杂志,2017,32(1):91-95.DOI:10.3870/j.issn.1001-4152.2017.01.091.
[12] 周松,王建宁,詹梦梅,等.不同胃残留量阈值设置对ICU行肠内营养患者影响的系统评价[J].中华临床营养杂志,2018,26(1):9-16.DOI:10.3760/cma.j.issn.1674-635X. 2018.01.002.
[13] McClave S A, Snider H L.Clinical Use of Gastric Residual Volumes as A Monitor for Patients on Enteral Tube Feeding[J]. JPEN J Parenter Enteral Nutr, 2002,26(6):S43-S49. DOI:10.1177/014860710202600607.
[14] Kuppinger D D, Rittler P, Hartl W H.Use of Gastric Residual Volume to Guide Enteral Nutrition in Critically Ill Patients: A Brief Systematic Review of Clinical Studies[J].Nutrition, 2013, 29(9):1075-1079.DOI:10.1016/j.nut.2013.01.025.
[15] Pham C H, Collier Z J, Garner W L,et al.Measuring Gastric Residual Volumes in Critically Ill Burn Patients - A Systematic Review[J].Burns,2018,S0305-4179(18):30386-3. DOI:10.1016/j.burns.2018.05.011.
[16] Kim H, Chang S J.Clinical Usefulness of Gastric Residual Volume as an Indicator to Provide Approximately Enteral Nutrition for Patients in Intensive Care Units: A Systematic Literature Review[J]. JKBNS,2014, 16(4):267-275. DOI: 10.7586/jkbns.2014.16.4.267.
[17] 米元元,沈月,黄海燕,等.ICU患者肠内营养并发腹泻证据汇总[J].护理学报,2017,24(21):58-66. DOI:10.16460/j.issn1008-9969.2017.21.058.
[18] Alberda C, Gramlich L, Jones N, et al.The Relationship between Nutritional Intake and Clinical Outcomes in Critically Ill Patients: Results of An International Multicenter Obser -vational Study[J]. Intensive Care Med,2009,35(10):1728-1737.DOI:10.1007/ s00134 -009-1567-4
[19] Heydari A, Emami Zeydi A.Is Gatric Residual Volume Monitoring in Critically Ill Patients Receiving Mechanical Ventilation an Evidence-based Practice?[J].Indian J Crit Care Med,2014,18(4):259-260.
[20] Elke G, Felbinger T W, Heyland D K.Gastric Residual Volume in Critically Ill Patients: A Dead Marker or Still Alive?[J].Nutr CAin Pract, 2015, 30(1):59-71.DOI:10.1177//1388453614562841.

相关文章 15

[1]	杨小娟, 毛孝容, 王静, 江华, 李蓉, 樊宇, 文青, 李林章, 陈晓容. 成人重度烧伤患者早期肠内营养管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 56-61.
[2]	周越, 张杰, 潘宇帆, 戴雨, 孙羽健, 肖益, 余雨枫. 机械通气患者衰弱风险预测模型的系统评价[J]. 护理学报, 2024, 31(6): 56-61.
[3]	黄润, 张海波, 刘萍. 基于血糖优化的早期间断肠内营养在心脏瓣膜置换术后应激性高血糖患者中的应用[J]. 护理学报, 2024, 31(15): 68-72.
[4]	李颖馨, 陈琼, 范玲, 徐红贞, 胡晓静, 蒙景雯, 林艳, 彭文涛. 新生儿重症监护室住院早产儿发育支持护理的最佳证据总结[J]. 护理学报, 2024, 31(11): 28-34.
[5]	熊厚仁, 方迎迎, 朱明华, 郭兰彩, 倪秀梅, 陈浩. 早期肠内营养耐受性分级干预方案在心脏外科术后重症患者中的应用[J]. 护理学报, 2023, 30(9): 64-68.
[6]	孔珊珊, 李素云, 柯卉, 杨赛, 黄海燕, 万青, 程湘玮, 史雯嘉, 刘芳, 晏蓉, 刘云访, 刘天艺. 肠内营养住院患者并发高血糖风险预警分级及干预方案的构建[J]. 护理学报, 2023, 30(22): 68-73.
[7]	胡梨萍, 朱晓丽, 赵媛, 鲁玉苗, 黄友鹏, 阳晴, 杨建飞, 肖娟, 陈宇. 国内外ICU后门诊发展现状及展望[J]. 护理学报, 2023, 30(21): 34-38.
[8]	王窈, 管玉香, 郑静, 许娟, 王超. 持续血糖监测在糖尿病患者中应用的系统评价再评价[J]. 护理学报, 2023, 30(21): 39-45.
[9]	朱明月, 史纪元, 李峥. 计算机化认知训练对认知功能障碍患者干预效果的系统评价再评价[J]. 护理学报, 2023, 30(21): 46-53.
[10]	张乔, 刘昌丹, 鲁小小, 周娟, 丁娟. 基于理论域框架的护士临床应用指南规范实施肠内营养的障碍因素分析[J]. 护理学报, 2023, 30(20): 63-67.
[11]	方业香, 韩江英, 王祚传, 齐梦影, 伍姗姗, 李娟. 252名ICU护士生命意义感现状及影响因素分析[J]. 护理学报, 2023, 30(1): 60-63.
[12]	陈怿, 杨赛, 晏蓉, 熊照玉, 万雅莉, 李素云. 基于精细化管理ORTCC模型构建结直肠癌患者口服营养补充方案[J]. 护理学报, 2022, 29(23): 67-71.
[13]	苏小平, 徐静娟, 赵亚东, 张允, 陈建芬. 危重患者早期肠内营养喂养不耐受风险预测模型的构建[J]. 护理学报, 2022, 29(17): 47-51.
[14]	傅亚丽, 张先红, 范娟, 朱小川, 魏璐. 新生儿重症监护室中家庭参与式护理实践及建议的质性研究[J]. 护理学报, 2022, 29(14): 7-11.
[15]	李晨曦, 沈梅芬. 肠内营养半固化对管饲喂养患者胃肠道耐受性影响的Meta分析[J]. 护理学报, 2021, 28(9): 43-47.

Metrics

Viewed

Full text

Abstract

Cited

Shared