PICU危重患儿肠内营养及喂养实践现状的多中心调查
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摘要
目的了解PICU危重患儿肠内营养及喂养的实施现状。方法自制调查表对15所医院PICU的危重患儿肠内营养及喂养的实践现状进行调查。结果仅4个PICU成立营养团队并参与临床营养工作;共11个PICU对危重患儿进行营养评估并且滞留期间定期评估患儿营养状况变化。监测环节中,有14个PICU将胃残余量作为喂养监测指标,但所设定的阈值存在差异,10个PICU将奶量的50%作为高胃残余量定义。结论我国PICU喂养临床实践中缺乏多学科合作,营养师参与度较低,喂养实施行为变异度较大。需要根据我国国情构建基于循证的标准化喂养流程,规范危重患儿喂养行为,改善危重患儿营养状况。
引文
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[7] 王烨,于欣平,曹薇,等.行业自治视域下的营养师职业资格认定与管理[J].中国食物与营养,2017,23(2):5-7.
[8] 王建,易龙,舒晓亮.我国临床营养学科的现状与存在问题[J].中国食物与营养,2012,18(7):5-9.
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[10] 张慧文,顾莺,杨玉霞,等.STAMP量表筛检住院儿童营养不良风险的系统评价[J].护理学杂志,2016,31(7):85-90.
[11] Rubens F,Delgado A F,Zamberlan P,et al.Challenges of nutritional assessment in pediatric ICU[J].Curr Opin Clin Nutr Metab Care,2009,12(3):245-250.
[12] Israels T,Chirambo C,Caron H N,et al.Nutritional status at admission of children with cancer in Malawi[J].Pediatr Blood Cancer,2008,51(5):626-628.
[13] Ravasco P,Camilo M E,Gouveia-Oliveira A,et al.A cri-tical approach to nutritional assessment in critically ill patients[J].Clin Nutr,2002,21(1):73-77.
[14] Stephen A M,Harvy L S.Clinical use of gastric residual volumes as a monitor[J].Jpen J Parenter Enteral Nutr,2002,26(6):43-50.
[15] Elke G,Felbinger T W,Heyland D K.Gastric residual volume in critically ill patients:a dead marker or still alive?[J].Nutr Clin Pract,2015,30(1):59-71.
[16] Kar P,Jones K L,Horowitz M,et al.Measurement of gastric emptying in the critically ill[J].Clin Nutr,2015,34(4):557-564.
[17] Stephen A M,Beth E T,Robert G M,et al.Guidelines for the provision and assessment of nutrition support therapy in the adultcritically ill patient:Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition[J].JPEN J Parenter Enteral Nutr,2016,40(2):159-211.
[18] Dutta S,Singh B,Chessell L,et al.Guidelines for feeding very low birth weight infants[J].Nutrients,2015,7(1):423-442.
[19] Mehta N M,Mcaleer D,Hamilton S,et al.Challenges to optimal enteral nutrition in a multidisciplinary pediatric intensive care unit[J].JPEN J Parenter Enteral Nutr,2010,34(1):38-45.
[20] Booth C M,Heyland D K,Paterson W G.Gastrointestinal promotility drugs in the critical care setting:a systematic review of the evidence[J].Crit Care Med,2002,30(7):1429-1435.
[21] Dhaliwal R,Cahill N,Lemieux M,et al.The Canadian Critical Care Nutrition Guidelines in 2013[J].Nutr Clin Pract,2014,29(1):29-43.
[2] Grippa R B,Silva P S,Barbosa E,et al.Nutritional status as a predictor of duration of mechanical ventilation in critically ill children[J].Nutrition,2017,33:91-95.
[3] 中华医学会肠外肠内营养学分会儿科协作组.中国儿科肠内肠外营养支持临床应用指南[J].2010,48(6):436-441.
[4] Lambe C,Hubert P,Jouvet P,et al.A nutritional support team in the pediatric intensive care unit:changes and factors impeding appropriate nutrition[J].Clin Nutr,2007,26(3):355-363.
[5] Mo Y H,Rhee J,Lee E K.Effects of nutrition support team services on outcomes in ICU patients[J].Yakugaku Zasshi,2011,131(12):1827-1833.
[6] 陈艳鸿,许建强,梁健球.营养支持小组对ICU患者营养支持状况的影响[J].白求恩军医学院学报,2009,7(1):10-11.
[7] 王烨,于欣平,曹薇,等.行业自治视域下的营养师职业资格认定与管理[J].中国食物与营养,2017,23(2):5-7.
[8] 王建,易龙,舒晓亮.我国临床营养学科的现状与存在问题[J].中国食物与营养,2012,18(7):5-9.
[9] Mehta N M,Skillman H E,Irving S Y,et al.Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient:Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition[J].JPEN J Parenter Enteral Nutr,2017,41(5):706-742.
[10] 张慧文,顾莺,杨玉霞,等.STAMP量表筛检住院儿童营养不良风险的系统评价[J].护理学杂志,2016,31(7):85-90.
[11] Rubens F,Delgado A F,Zamberlan P,et al.Challenges of nutritional assessment in pediatric ICU[J].Curr Opin Clin Nutr Metab Care,2009,12(3):245-250.
[12] Israels T,Chirambo C,Caron H N,et al.Nutritional status at admission of children with cancer in Malawi[J].Pediatr Blood Cancer,2008,51(5):626-628.
[13] Ravasco P,Camilo M E,Gouveia-Oliveira A,et al.A cri-tical approach to nutritional assessment in critically ill patients[J].Clin Nutr,2002,21(1):73-77.
[14] Stephen A M,Harvy L S.Clinical use of gastric residual volumes as a monitor[J].Jpen J Parenter Enteral Nutr,2002,26(6):43-50.
[15] Elke G,Felbinger T W,Heyland D K.Gastric residual volume in critically ill patients:a dead marker or still alive?[J].Nutr Clin Pract,2015,30(1):59-71.
[16] Kar P,Jones K L,Horowitz M,et al.Measurement of gastric emptying in the critically ill[J].Clin Nutr,2015,34(4):557-564.
[17] Stephen A M,Beth E T,Robert G M,et al.Guidelines for the provision and assessment of nutrition support therapy in the adultcritically ill patient:Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition[J].JPEN J Parenter Enteral Nutr,2016,40(2):159-211.
[18] Dutta S,Singh B,Chessell L,et al.Guidelines for feeding very low birth weight infants[J].Nutrients,2015,7(1):423-442.
[19] Mehta N M,Mcaleer D,Hamilton S,et al.Challenges to optimal enteral nutrition in a multidisciplinary pediatric intensive care unit[J].JPEN J Parenter Enteral Nutr,2010,34(1):38-45.
[20] Booth C M,Heyland D K,Paterson W G.Gastrointestinal promotility drugs in the critical care setting:a systematic review of the evidence[J].Crit Care Med,2002,30(7):1429-1435.
[21] Dhaliwal R,Cahill N,Lemieux M,et al.The Canadian Critical Care Nutrition Guidelines in 2013[J].Nutr Clin Pract,2014,29(1):29-43.