早产儿胃潴留评估与处理的最佳证据总结及应用效果研究

doi:10.3761/j.issn.2096-7446.2025.10.004

摘要/Abstract

摘要：

目的整合早产儿胃潴留的评估与处理的最佳证据，并评价其应用效果。方法整合早产儿胃潴留评估与处理的最佳证据，经过基线审查、障碍因素与促进因素分析并构建最佳循证实践方案，于2023年9月—12月在湖北省某三级甲等医院新生儿重症监护病房实施，比较证据应用前后医护人员的认知程度、对审查指标的执行率以及患儿的临床结局。结果最终纳入10条最佳证据，证据应用后护士对早产儿胃潴留评估及处理证据知晓率提高，各指标认知程度达80%以上；医护人员循证实践行为依从性提高，各指标执行率达75%以上；早产儿肠外营养时间缩短（P<0.05）。结论早产儿胃潴留评估与处理的最佳证据总结与应用提高了医护人员的认知程度并且规范了实践行为，有利于改善患儿结局。

关键词: 早产儿, 胃潴留, 循证护理学, 最佳证据

Abstract:

Objective To integrate the best evidence for the assessment and management of gastric retention in premature infants and apply it in clinical practice，and evaluate the application effects. Methods The best evidence for the assessment and management of gastric retention in premature infants was integrated. After baseline audits，analysis of barriers and facilitators，an optimal evidence-based practice protocol was developed and implemented in the Neonatal Intensive Care Unit（NICU） of a tertiary hospital from September to December 2023. Healthcare professionals’ cognitive levels，the implementation rates of audit indicators and the clinical outcomes of the infants were compared before and after the application of the evidence. Results Ultimately，10 pieces of best evidence were included. After the application of the evidence，nurses’ awareness of the evidence for assessing and managing gastric retention in premature infants increased，with cognitive levels for each indicator exceeding 80%. Healthcare professionals’ compliance with evidence-based practice behaviors improved，with implementation rates for each indicator exceeding 75%. The duration of parenteral nutrition in premature infants was shortened（P<0.05）. Conclusion The development and application of the best evidence for the assessment and management of gastric retention in premature infants improved healthcare professionals’ knowledge and standardized practice behaviors，which was beneficial for improving patient outcomes.

Key words: Premature Infants, Gastric Retention, Evidence-Based Nursing, Best Evidence

李畅, 余艮珍, 丁玲莉, 韩玲芝, 王文超. 早产儿胃潴留评估与处理的最佳证据总结及应用效果研究[J]. 中华急危重症护理杂志, 2025, 6(10): 1175-1182.

LI Changyan, YU Genzhen, DING Lingli, HAN Lingzhi, WANG Wenchao. Summary of the best evidence for the assessment and management of gastric retention in preterm infants and application effects[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(10): 1175-1182.

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参考文献 21

[1]	Martínez-Jiménez MD, Gómez-García FJ, Gil-Campos M, et al. Comorbidities in childhood associated with extrauterine growth restriction in preterm infants:a scoping review[J]. Eur J Pediatr, 2020, 179(8):1255-1265. doi: 10.1007/s00431-020-03613-8 pmid: 32096070
[2]	梁慧杰, 丁玲莉. 口腔运动干预联合袋鼠式护理改善早产儿喂养困难及神经发育的效果分析[J]. 全科护理, 2021, 19(28):3990-3992.
	Liang HJ, Ding LL. Effect analysis of oral exercise intervention combined with kangaroo nursing on improving feeding difficulties and neurological development of premature infants[J]. Chin Gen Pract Nurs, 2021, 19(28):3990-3992.
[3]	Abiramalatha T, Thanigainathan S, Ramaswamy VV, et al. Routine monitoring of gastric residual for prevention of necrotising enterocolitis in preterm infants[J]. Cochrane Database Syst Rev, 2023, 6(6):CD012937.
[4]	吕天婵, 张玉侠. 早产儿胃潴留管理相关研究进展[J]. 中国护理管理, 2015, 15(12):1525-1528.
	Lü TC, Zhang YX. Research progress on the management of gastric residual in preterm infants[J]. Chin Nurs Manag, 2015, 15(12):1525-1528.
[5]	Abiramalatha T, Thanigainathan S, Ramaswamy VV, et al. Re-feeding versus discarding gastric residuals to improve growth in preterm infants[J]. Cochrane Database Syst Rev, 2023, 6(6):CD012940.
[6]	Hare L, Boyle E. Does prefeed gastric residual evaluation impair enteral nutrition intake in very preterm infants?[J]. Acta Paediatr, 2020, 109(4):859-860.
[7]	Elia S, Ciarcià M, Miselli F, et al. Effect of selective gastric residual monitoring on enteral intake in preterm infants[J]. Ital J Pediatr, 2022, 48(1):30. doi: 10.1186/s13052-022-01208-7 pmid: 35177107
[8]	Lenfestey MW, Li N, Gauthier J, et al. Effect of routine gastric residual aspiration on the preterm infant fecal microbiome[J]. Am J Perinatol, 2024, 41(S 01):e212-e220.
[9]	Branagan A, Murphy C, O’Sullivan A, et al. Influence of gastric residual assessment in preterm neonates on time to achieve enteral feeding(the GRASS trial)-Multi-centre,assessor-blinded randomised clinical trial[J]. Eur J Pediatr, 2024, 183(5):2325-2332. doi: 10.1007/s00431-024-05483-w pmid: 38427039
[10]	韦当, 王聪尧, 肖晓娟, 等. 指南研究与评价(AGREEⅡ)工具实例解读[J]. 中国循证儿科杂志, 2013, 8(4):316-319.
	Wei D, Wang CY, Xiao XJ, et al. Interpretation of the tools of AGREEⅡ[J]. Chin J Evid Based Pediatr, 2013, 8(4):316-319.
[11]	胡雁. 循证护理学[M]. 北京: 人民卫生出版社,2012:151-153.
	Hu Y. Evidence-based nursing[M]. Beijing: People’s Medical Publishing House,2012:151-153.
[12]	Dutta S, Singh B, Chessell L, et al. Guidelines for feeding very low birth weight infants[J]. Nutrients, 2015, 7(1):423-442. doi: 10.3390/nu7010423 pmid: 25580815
[13]	Kültürsay N, Bilgen H, Türkyılmaz C. Turkish Neonatal Society guideline on enteral feeding of the preterm infant[J]. Turk Pediatri Ars, 2018, 53(Suppl 1):S109-S118.
[14]	Kumar RK, Singhal A, Vaidya U, et al. Optimizing nutrition in preterm low birth weight infants-consensus summary[J]. Front Nutr, 2017,4:20.
[15]	李敏敏, 司在霞, 刘进, 等. 早产儿喂养不耐受预防及管理的最佳证据总结[J]. 中华护理杂志, 2020, 55(8):1163-1168. doi: 10.3761/j.issn.0254-1769.2020.08.007
	Li MM, Si ZX, Liu J, et al. Evidence summary for prevention and management of feeding intolerance in preterm infants[J]. Chin J Nurs, 2020, 55(8):1163-1168. doi: 10.3761/j.issn.0254-1769.2020.08.007
[16]	杜世正, 胡雁, 周英凤, 等. 推动证据向临床转化(十六)从理论到实践:基于i-PARIHS模式的指南转化动态路径图[J]. 护士进修杂志, 2020, 35(22):2077-2081.
	Du SZ, Hu Y, Zhou YF, et al. From theory to practice:introduction of the dynamic pathway for guidelines implementa-tion based on i-PARIHS model[J]. J Nurses Train, 2020, 35(22):2077-2081.
[17]	江载芳, 申昆玲, 沈颖. 诸福棠实用儿科学(第8版)[M]. 北京: 人民卫生出版社,2015:496-498.
	Jiang ZF, Shen KL, Shen Y. Zhu Futang practical pediatrics (8th Ed.)[M]. Beijing: People’s Medical Publishing House,2015:496-498.
[18]	中国医师协会新生儿科医师分会循证专业委员会. 早产儿喂养不耐受临床诊疗指南(2020)[J]. 中国当代儿科杂志, 2020, 22(10):1047-1055.
	Evidence-based Professional Committee of Neonatologists Branch of Chinese Medical Doctor Association. Clinical guidelines for the diagnosis and treatment of feeding intolerance in preterm infants(2020)[J]. Chin J Contemp Pediatr, 2020,22:1047-1055.
[19]	韩柳, 晏利姣, 姜雨婷, 等. PARIHS循证概念框架的演变及其应用思考[J]. 护理学杂志, 2017, 32(9):84-86,89.
	Han L, Yan LJ, Jiang YT, et al. Evolution and application thinking of the PARIHS evidence based conceptual framework[J]. J Nurs Sci, 2017, 32(9):84-86,89.
[20]	Athalye-Jape G, Nettleton M, Lai CT, et al. Composition of coloured gastric residuals in extremely preterm infants-a nested prospective observational study[J]. Nutrients, 2020, 12(9):2585.
[21]	Akar S, Turgut M. Do we control gastric residuals unnecessarily in premature newborns? AGRA study:avoidance of gastric residual aspiration[J]. World J Pediatr Surg, 2020, 3(1):e000056.