体外膜肺氧合患者早期接受肠内营养安全性与有效性的系统评价

doi:10.3761/j.issn.2096-7446.2024.08.014

摘要/Abstract

摘要： 目的系统评价体外膜肺氧合（extracorporeal membrane oxygenation,ECMO）患者早期接受肠内营养的安全性和有效性,为ECMO患者早期接受肠内营养的临床决策提供参考。方法检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、Cochrane图书馆、PubMed、Embase、Web of Science数据库,检索时间为建库至2023年12月30日,由2名经过循证培训的研究人员根据纳入和排除标准独立进行文献筛选和资料提取,对纳入文献的质量进行汇总分析。结果共纳入文献11篇,共计2 455例ECMO早期肠内营养患者,ECMO患者早期接受肠内营养不会增加胃残余、肠道不耐受、严重腹部并发症的发生率,同时能够实现目标喂养率、降低患者病死率。结论 ECMO患者早期进行肠内营养安全有效,对预后有积极的影响。

关键词: 体外膜肺氧合技术, 肠内营养, 喂养不耐受, 系统评价, 循证护理学

Abstract: Objective To systematically evaluate the safety and effectiveness of early enteral nutrition in patients with extracorporeal membrane oxygenation（ECMO）,and to provide reference for clinical decision of early enteral nutrition in ECMO patients. Methods CNKI,WanFang Database,VIP Database,Chinese Biomedical Literature Database,Cochrane Library,PubMed,Embase,Web of Science were searched,the retrieval limit was from inception to December 30,2023. Two researchers who received evidence based training screened the literature according to the inclusion and exclusion criteria,extracted data,assessed the quality of included studies and integrated the data independently. Results Finally,11 articles were included,with a total of 2 455 patients with early enteral nutrition in ECMO patients. Early enteral nutrition in ECMO patients did not increase the incidence of gastric remnants,intestinal intolerance,and severe abdominal complications,it could achieve target feeding rates and reduce mortality. Conclusion Early enteral nutrition in ECMO patients is safe and effective,it has a positive impact on prognosis.

Key words: Extracorporeal Membrane Oxygenation Technology, Enteral Nutrition, Feeding Intolerance, Systematic Review, Evidence-Based Nursing

艾闪闪, 牛鹏丽, 王悦, 肖文俊, 徐国君. 体外膜肺氧合患者早期接受肠内营养安全性与有效性的系统评价[J]. 中华急危重症护理杂志, 2024, 5(8): 741-746.

AI Shanshan, NIU Pengli, WANG Yue, XIAO Wenjun, XU Guojun. The safety and effectiveness of early enteral nutrition in patients with extracorporeal membrane oxygenation：a systematic review[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(8): 741-746.

参考文献

[1] de Freitas Chaves RC,Rabello Filho R,Timenetsky KT,et al. Extracorporeal membrane oxygenation:a literature review[J]. Rev Bras De Terapia Intensiva,2019,31(3):410-424.
[2] Karpasiti T,Puthucheary Z,Zolfaghari P.An exploration of nu-tritional adequacy in patien-tsreceiving extracorporeal mem-brane oxygenation andeffects on gastrointestinal and physical-function[J]. J Human Nutrit Dietet,2021,34(suppl 1):26-27.
[3] Reintam Blaser A,Starkopf J,Alhazzani W,et al.Early enteral nutrition in critically ill patients:ESICM clinical practice guidelines[J]. Intensive Care Med,2017,43(3):380-398.
[4] Guglin M,Zucker MJ,Bazan VM,et al.Venoarterial ECMO for adults:JACC scientific expert panel[J]. J Am Coll Cardiol,2019,73(6):698-716.
[5] Kim S,Jeong SK,Hwang J,et al.Early enteral nutrition and factors related to in-hospital mortality in people on extracor-poreal membrane oxygenation[J]. Nutrition,2021,89:111222.
[6] 顾莺,张慧文,周英凤,等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:分析性研究的质量评价(二)[J]. 护士进修杂志,2018,33(6):513-516.
Gu Y,Zhang HW,Zhou YF,et al.The joanna briggs institute critical appraisal tools use in systematicreviews:analytic study[J]. J Nurses Train,2018,33(6):513-516.
[7] 周英凤,顾莺,胡雁,等. JBI循证卫生保健中心对关于不同类型研究的质量评价工具:患病率及分析性横断面研究的质量评价[J]. 护士进修杂志,2018,33(3):219-221.
Zhou YF,Gu Y,Hu Y,et al.The joanna briggs institute critical appraisal tools for use in systematic review:prevalence study and analytical cross sectional study[J]. J Nurses Train,2018,33(3):219-221.
[8] 王晓航,孟树萍,胡延磊,等. 早期肠内营养对成人心脏术后静脉-动脉体外膜肺氧合患者近期预后的影响[J]. 中国急救医学,2023,43(8):628-631.
Wang XH,Meng SP,Hu YL,et al.Effects of early enteral nutrition on short-term prognosis of adult patients receiving veno-arterial extracorporeal membrane oxygenation after cardiac surgery[J]. Chin J Crit Care Med,2023,43(8):628-631.
[9] Lu GY,Xu H,Li JH,et al.Safety and outcome of early enteral nutrition in patients receiving extracorporeal membrane oxygenation[J]. Clin Nutr,2023,42(9):1711-1714.
[10] Gutierrez A,Carlson C,Kalra R,et al.Outcomes associated with delayed enteral feeding after cardiac arrest treated with veno-arterial extracorporeal membrane oxygenation and targe-ted temperature management[J]. Resuscitation,2021,164:20-26.
[11] Ohbe H,Jo T,Yamana H,et al.Early enteral nutrition for cardiogenic or obstructive shock requiring venoarterial extra-corporeal membrane oxygenation:a nationwide inpatient data-base study[J]. Intensive Care Med,2018,44(8):1258-1265.
[12] 丁毅,周妃妃,金雨虹,等. 早期肠内营养对静脉-动脉体外膜肺氧合患者预后的影响[J]. 中国中西医结合急救杂志,2018, 25(6):612-615.
Ding Y,Zhou FF,Jin YH,et al.Effect of early enteral nut-rition on prognosis of patients during veno-arterial extracor-poreal membrane oxygenation[J]. Chin J Integr Tradit West Med Intensive Crit Care,2018,25(6):612-615.
[13] Lu MC,Yang MD,Li PC,et al.Effects of nutritional inter-vention on the survival of patients with cardiopulmonary failure undergoing extracorporeal membrane oxygenation thera-py[J]. In Vivo,2018,32(4):829-834.
[14] Ridley EJ,Davies AR,Robins EJ,et al.Nutrition therapy in adult patients receiving extracorporeal membrane oxygenation:a prospective,multicentre,observational study[J]. Crit Care Resusc, 2015,17(3):183-189.
[15] Umezawa Makikado LD,Flordelís Lasierra JL,Pérez-Vela JL,et al.Early enteral nutrition in adults receiving venoarterial extracorporeal membrane oxygenation:an observational case series[J]. JPEN J Parenter Enteral Nutr,2013,37(2):281-284.
[16] Ferrie S,Herkes R,Forrest P.Nutrition support during extra-corporeal membrane oxygenation(ECMO) in adults:a retros-pective audit of 86 patients[J]. Intensive Care Med,2013,39(11):1989-1994.
[17] Scott LK,Boudreaux K,Thaljeh F,et al.Early enteral feedings in adults receiving venovenous extracorporeal membrane oxy-genation[J]. JPEN J Parenter Enteral Nutr,2004,28(5):295-300.
[18] D'Alesio M,Martucci G,Arcadipane A,et al. Nutrition during extracorporeal life support:a review of pathophysiological bases and application of guidelines[J]. Artif Organs,2022,46(7):1240-1248.
[19] Faisy C,Lerolle N,Dachraoui F,et al.Impact of energy de-ficit calculated by a predictive method on outcome in medi-cal patients requiring prolonged acute mechanical ventilation[J]. Br J Nutr,2009,101(7):1079-1087.
[20] Alberda C,Gramlich L,Jones N,et al.The relationship bet-ween nutritional intake and clinical outcomes in critically ill patients:results of an international multicenter observational study[J]. Intensive Care Med,2009,35(10):1728-1737.
[21] Robledo-Valdez M,Carrera-Quintanar L,Morante-Ruiz M,et al.Medical nutrition therapy in patients receiving extracorporeal membrane oxygenation:knowledge in progress[J]. Arch Cardiol Mex,2023,93(3):348-354.
[22] 包益萍,张玲,俞臻梁. 成人ICU患者肠内营养喂养不耐受风险预测模型的研究进展[J]. 中华急危重症护理杂志,2023,4(6):562-568.
Bao YP,Zhang L,Yu ZL.Research progress on risk predic-tion model of enteral nutritionfeeding intolerance in adult ICU patients[J]. Chin J Emerg Crit Care Nurs,2023,4(6):562-568.
[23] 向波,刘丽萍,黄萍. 急性肠系膜缺血患者营养支持的范围综述[J]. 中华急危重症护理杂志, 2023,4(2):119-124.
Xiang B,Liu LP,Huang P.Nutritional support in patients with acute mesenteric ischemia:a scoping review[J]. Chin J Emerg Crit Care Nurs,2023,4(2):119-124.
[24] Khalid I,Doshi P,DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation[J]. Am J Crit Care,2010,19(3):261-268.
[25] 余昆容,夏莹,赵淑雅,等. 持续肠内营养患者胃残余量变化趋势及喂养达标的影响因素研究[J]. 中华护理杂志,2021,56(1):50-55.
Yu KR,Xia Y,Zhao SY,et al.Variation trend of gastric residual volume and influencing factors of full feeding in patients receiving continuous enteral nutrition[J]. Chin J Nurs,2021,56(1):50-55.
[26] Ozen N,Blot S,Ozen V,et al.Gastric residual volume mea-surement in the intensive care unit:an international survey reporting nursing practice[J]. Nurs Crit Care,2018,23(5):263-269.
[27] Bruni A,Garofalo E,Grande L,et al.Nursing issues in enteral nutrition during prone position in critically ill patients:a systematic review of the literature[J]. Intensive Crit Care Nurs,2020,60:102899.
[28] Albrecht HC,Trawa M,Gretschel S.Nonocclusive mesenteric ischemia associated with postoperative jejunal tube feeding:indicators for clinical management[J]. J Int Med Res,2020, 48(8):300060520929128.
[29] McClave SA,Chang WK. Feeding the hypotensive patient:does enteral feeding precipitate or protect against ischemic bowel?[J]. Nutr Clin Pract,2003,18(4):279-284.