ISSN 2097-6046(网络)
ISSN 2096-7446(印刷)
CN 10-1655/R
主管:中国科学技术协会
主办:中华护理学会
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护士在重症患者胃肠功能障碍精准化管理中的作用

  • 周新艺 ,
  • 邓海波 ,
  • 孙建华 ,
  • 徐园 ,
  • 郭淑丽 ,
  • 马玉芬
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  • 100730 北京市 中国医学科学院北京协和医学院北京协和医院护理部(周新艺),心外科(邓海波),重症医学科(孙建华),保健医疗部(徐园),基本外科(郭淑丽),工会(马玉芬)
周新艺:女,本科(硕士在读),护士,E-mail:2529783494@qq.com

收稿日期: 2023-11-06

  网络出版日期: 2024-10-21

基金资助

北京市科学技术委员会“首都临床诊疗技术研究及转化应用”项目(Z201100005520007)

The role of nurses in precise management of gastrointestinal dysfunction in critically ill patients

  • ZHOU Xinyi ,
  • DENG Haibo ,
  • SUN Jianhua ,
  • XU Yuan ,
  • GUO Shuli ,
  • MA Yufen
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Received date: 2023-11-06

  Online published: 2024-10-21

摘要

重症患者胃肠功能障碍防治至关重要,护理人员参与患者胃肠功能评估、症状管理、营养支持、并发症监测的全流程,起到举足轻重的作用。近年来,国内外在重症患者胃肠功能障碍管理方面涌现出许多新证据、新观点,呈现以症状为导向,精准化护理管理的新趋势。该文将从胃肠功能障碍高风险患者的早期识别、基于超声引导的胃肠功能精准化监测及循证护理方案的规范落实3个方面对重症患者胃肠功能障碍管理进行介绍,总结护士在重症患者精准化胃肠功能管理中所承担的职责,并对如何最优发挥护士价值提出了建议。

本文引用格式

周新艺 , 邓海波 , 孙建华 , 徐园 , 郭淑丽 , 马玉芬 . 护士在重症患者胃肠功能障碍精准化管理中的作用[J]. 中华急危重症护理杂志, 2024 , 5(10) : 957 -960 . DOI: 10.3761/j.issn.2096-7446.2024.10.017

Abstract

The prevention and management of gastrointestinal dysfunction in critically ill patients is very important,and nursing staff participate in the whole process of gastrointestinal function assessment,symptom management,nutritional support and complication monitoring of patients,which plays a pivotal role. In recent years,a lot of new evidence and new ideas have emerged in the management of gastrointestinal dysfunction in critically ill patients at home and abroad,showing a new trend of symptom-oriented and precise nursing management. This paper introduced the management of gastrointestinal dysfunction in critically ill patients from three aspects,namely early identification of high-risk patients with gastrointestinal dysfunction,ultrasound-guided precision monitoring of gastrointestinal function and standardized implementation of evidence-based nursing programs. And it also summarized the responsibilities of nurses in the precise management of gastrointestinal function in critically ill patients,put forward the suggestions on how to exert the value of nurses.

参考文献

[1] Reintam Blaser A,Malbrain MLNG,Starkopf J,et al.Gastrointestinal function in intensive care patients:terminology,definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems[J]. Intensive Care Med,2012,38(3):384-394.
[2] 房雨萌. 河北省重症患者营养支持与急性胃肠功能损伤现状调查[D]. 石家庄:河北医科大学,2015.
Fang YM.Investigation on nutritional support and acute gastrointestinal function injury of severe patients in Hebei Province[D]. Shijiazhuang:Hebei Medical University,2015.
[3] Padar M,Starkopf J,Uusvel G,et al.Gastrointestinal failure affects outcome of intensive care[J]. J Crit Care,2019,52:103-108.
[4] 李娟,李曙平,吴娜. 胃肠功能障碍和衰竭对老年危重病患者临床预后的影响[J]. 现代中西医结合杂志,2012,21(1):25-26,34.
Li J,Li SP,Wu N.Influence of gastrointestinal dysfunction and failure on clinical prognosis in the elderly with critical illness[J]. Mod J Integr Tradit Chin West Med,2012,21(1):25-26,34.
[5] 上海市中西医结合学会急救专业委员会,上海市中西医结合学会重症医学专业委员会,上海市医师协会急诊科医师分会,等. 脓毒症急性胃肠功能障碍中西医结合临床专家共识[J]. 中华危重病急救医学,2022,34(2):113-120.
Emergency Medicine Professional Committee of Shanghai Integrated Traditional Chinese and Western Medicine Association,Intensive Care Medicine Professional Committee of Shanghai Integrated Traditional Chinese and Western Medicine Association,Emergency Physicians Branch of Shanghai Physicians Association,et al. Expert consensus on gastrointestinal dysfunction secondary to sepsis with integrating traditional Chinese medicine and Western medicine[J]. Chin J Crit Care Med,2022,34(2):113-120.
[6] 陈怀生,张华东,周志强,等. 欧洲腹部疾病工作组急性胃肠功能损伤工作指南在ICU患者中的应用[J]. 中国全科医学,2015,18(2):236-238.
Chen HS,Zhang HD,Zhou ZQ,et al.Clinical application of acute gastrointestinal injury working guideline in ICU[J]. Chin Gen Pract,2015,18(2):236-238.
[7] McClave SA,Taylor BE,Martindale RG,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(A.S.P.E.N.)[J]. JPEN J Parenter Enteral Nutr,2016,40(2):159-211.
[8] 徐萍,倪兴梅. 预见性护理对ICU重症患者并发胃肠功能障碍的效果观察[J]. 国际护理学杂志,2019,38(7):976-978.
Xu P,Ni XM.Observation on the effect of predictive nursing on gastrointestinal dysfunction in ICU severe patients[J]. Int J Nurs,2019,38(7):976-978.
[9] Arunachala Murthy T,Chapple LS,Lange K,et al.Gastrointestinal dysfunction during enteral nutrition delivery in inten-sive care unit(ICU) patients:risk factors,natural history,and clinical implications. A post-hoc analysis of The Augmented versus Routine approach to Giving Energy Trial(TARGET)[J]. Am J Clin Nutr,2022,116(2):589-598.
[10] 杨雪. AGI分级标准对重症缺血性脑卒中患者胃肠功能障碍的评估价值及其在EEN中的应用分析[D]. 延吉:延边大学,2022.
Yang X.Evaluation value of AGI grading standard for gastrointestinal dysfunction in patients with severe ischemic stroke and its application in EEN[D]. Yanji:Yanbian University,2022.
[11] Liu XY,Wang QZ,Yang DQ,et al.Association between Gastrointestinal Dysfunction Score(GIDS) and disease severity and prognosis in critically ill patients:a prospective,observational study[J]. Clin Nutr,2023,42(5):700-705.
[12] Asrani VM,Brown A,Huang W,et al.Gastrointestinal dysfunction in critical illness:a review of scoring tools[J]. JPEN J Paren-ter Enteral Nutr,2020,44(2):182-196.
[13] Asrani VM,McArthur C,Bissett I,et al. The intensivist‘s assessment of gastrointestinal function:a pilot study[J]. Aust Crit Care,2022,35(6):636-643.
[14] 亚洲急危重症协会中国腹腔重症协作组. 重症病人胃肠功能障碍肠内营养专家共识(2021版)[J]. 中华消化外科杂志,2021,20(11):1123-1136.
Chinese Abdominal Critical Collaboration Group of Asian Critical Care Association. Expert consensus on enteral nutrition for gastrointestinal dysfunction in critically ill patients(2021 edition)[J]. Chin J Dig Surg,2021,20(11):1123-1136.
[15] 中国腹腔重症协作组. 重症患者腹内高压监测与管理专家共识(2020版). 中华消化外科杂志,2020,19(10):1030-1037.
Chinese Abdominal Intensive Care Collaboration Group. Expert consensus on monitoring and management of intraabdominal hypertension in severe patients(2020 edition)[J]. Chin J Dig Surg,2020,19(10):1030-1037.
[16] Pérez-Calatayud áA,Carillo-Esper R.Role of gastric ultrasound to guide enteral nutrition in the critically ill[J]. Curr Opin Clin Nutr Metab Care,2023,26(2):114-119.
[17] 中国研究型医院学会危重医学专业委员会,中国研究型医院学会危重医学专委会护理研究学组, 金歌,等. 基于循证的成人床旁超声护理专家共识[J]. 中华危重病急救医学,2020,32(9):1029-1039.
Critical Care Medicine Committee of China Research Hospital Association,Nursing Research Group of the Critical Care Medicine Committee of the China Research Hospital Association,Jin G,et al. Evidence-based nursing expert consensus on adult bedside ultrasound[J]. Chin Crit Care Med,2020,32(9):1029-1039.
[18] 孙建华,张青,李欣,等. 重症超声临床操作技术的护理规范[J]. 中华现代护理杂志,2023,29(16):2101-2112.
Sun JH,Zhang Q,Li X,et al.Nursing standards of clinical practice of critical care ultrasonography[J]. Chin J Mod Nurs,2023,29(16):2101-2112.
[19] 赵明曦,孙建华,李奇,等. 床旁超声评估重症患者胃肠功能的最佳证据总结[J]. 中华现代护理杂志,2022,28(5):602-610.
Zhao MX,Sun JH,Li Q,et al.Summary of the best evidence for the assessment of gastrointestinal function in critically ill patients by bedside ultrasound[J]. Chin J Mod Nurs,2022,28(5):602-610.
[20] 牛蓓蓓,李佳,王军,等. 神经外科监护室护士预防胃内容物误吸指南实施现状调查与分析[J]. 中华现代护理杂志,2018,24(13):1517-1521.
Niu BB,Li J,Wang J,et al.Investigation and analysis on the guidelines implementation status of preventing gastric aspiration of nurses in Neurosurgery ICU[J]. Chin J Mod Nurs,2018,24(13):1517-1521.
[21] 朱利思,陈军华,胡辉,等. 多学科协作团队工作坊教学模式应用于护士伤口护理培训的效果[J]. 解放军护理杂志,2019,36(9):85-88.
Zhu LS,Chen JH,Hu H,et al.The wound training workshop based on multidisciplinary team model for general nurses[J]. Nurs J Chin PLA,2019,36(9):85-88.
[22] Costa DK,Wallace DJ,Kahn JM.The association between daytime intensivist physician staffing and mortality in the context of other ICU organizational practices:a multicenter cohort study[J]. Crit Care Med,2015,43(11):2275-2282.
[23] 蒋清玲,卢雯. 应用MDT治疗1例肝门胆管癌行微波消融术后并发肠穿孔患者的护理[J]. 当代护士(下旬刊),2023,30(6):129-132.
Jiang QL,Lu W.Nursing care of a patient with intestinal perforation after microwave ablation of hilar cholangiocarcinoma treated with MDT[J]. Mod Nurse,2023,30(6):129-132.
[24] 陈倩,柴宇霞,胡琳琳,等. 多学科协同治疗模式护理团队在急诊多发伤患者救治效果中的初步探索[J]. 中华现代护理杂志,2019,25(34):4472-4475.
Chen Q,Chai YX,Hu LL,et al.Preliminary study on the effect of multiple disciplinary team model nursing team on the treatment of patients with multiple trauma in emergency department[J]. Chin J Mod Nurs,2019,25(34):4472-4475.
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