机械通气患者肠内营养相关性呕吐预防管理审查指标的制订及障碍因素分析

doi:10.3761/j.issn.2096-7446.2025.10.002

摘要/Abstract

摘要：

目的审查机械通气患者肠内营养相关性呕吐预防管理证据的临床应用现状，分析障碍因素和促进因素，制订变革策略，为证据的临床转化提供参考。方法通过前期总结的26条最佳证据制订审查指标并明确审查方法，应用实施性研究综合框架，从创新、外部因素、内部因素、个体特征和实施过程5个维度对审查结果进行障碍和促进因素分析，并制订变革策略。结果共制订31条审查指标，15条审查指标执行率<60%，其中4条审查指标执行率为0。障碍因素主要为呼吸重症监护病房护士肠内营养管理知识与培训不足、流程碎片化、设备及智能技术缺乏、多学科协作欠缺、医护的主观偏差等。促进因素主要为团队具备较好的证据转化能力、组织领导力强、医护人员变革积极性高及多学科协作潜力等。依此制订相应的变革策略，包括开展分层培训与绩效激励；完善流程并制度化；建立多学科团队协作，整合智能工具；部署动态质控反馈机制，鼓励医护人员提出改进建议，持续优化流程。结论机械通气患者肠内营养相关性呕吐预防管理的证据与临床实践存在差距，应科学全面地分析障碍因素和促进因素，制订针对性的改善策略和行动计划，以促进证据的临床转化。

关键词: 机械通气, 肠内营养, 呕吐, 审查指标, 障碍因素, 证据转化, 循证护理研究

Abstract:

Objective To review the current status of clinical application of evidence-based prevention and management of enteral nutrition-related vomiting in mechanically ventilated patients，analyze the barriers and facilitating factors，and establish reform strategies to provide a reference for the clinical transformation of evidence. Methods Audit indicators were developed and audit methods were defined through the 26 best pieces of evidence summarized in the previous stage. The consolidated framework for implementation research（CFIR） was applied to conduct an analysis of the barriers and facilitators of the audit results from five dimensions：innovation，external factors，internal factors，individual characteristics，and the implementation process，and to formulate reform strategies. Results A total of 31 audit indicators were formulated. Among them，the implementation rate of 15 indicators was less than 60%，and the implementation rate of 4 indicators was 0. The main barriers were the lack of knowledge and training of RICU nurses in enteral nutrition management，fragmented processes，the lack of equipment and intelligent technology，insufficient multidisciplinary collaboration，and the subjective biases of medical staff. The main facilitators were the relatively good evidence transformation ability of the team，strong organizational leadership，the high enthusiasm of medical staff for reform，and the potential for multidisciplinary collaboration. Based on this，corresponding reform strategies were formulated，including carrying out stratified training and performance incentives，perfecting the processes and institutionalization，establishing multidisciplinary team collaboration and integrating intelligent tools，deploying dynamic quality control feedback mechanisms，encouraging medical staff to put forward improvement suggestions and continuously optimizing the processes. Conclusion There is a gap between the evidence and clinical practice regarding the prevention and management of enteral nutrition-related vomiting in mechanically ventilated patients. It is necessary to scientifically and comprehensively analyze the barriers and promoting factors，formulate targeted improvement strategies and action plans，and promote the clinical transformation of evidence.

Key words: Mechanical Ventilation, Enteral Nutrition, Vomiting, Audit Indicators, Barriers, Evidence Transformation, Evidence-Based Nursing

向邱, 徐素琴, 蔡国旗, 付洁. 机械通气患者肠内营养相关性呕吐预防管理审查指标的制订及障碍因素分析[J]. 中华急危重症护理杂志, 2025, 6(10): 1162-1168.

XIANG Qiu, XU Suqin, CAI Gouqi, FU Jie. Development of audit indicators and barriers of prevention and management of enteral nutrition related vomiting in mechanically ventilated patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(10): 1162-1168.

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