Marshall Andrea P, West Sandra H
Critical Care Nursing Professorial Unit, The University of Technology, Sydney, Level 6 Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
Intensive Crit Care Nurs. 2006 Apr;22(2):95-105. doi: 10.1016/j.iccn.2005.09.004. Epub 2005 Nov 10.
Enteral feeding is the preferred method of nutritional support for the critically ill; however, a significant number of these patients are under-fed. It is possible that common nursing practices associated with the delivery of enteral feeding may contribute to under-feeding although there is little data available describing nursing practice in this area.
A descriptive survey-based design was used to explore the enteral feeding practices of 376 critical care nurses (response rate 50.5%). Participants completed a 57-item survey that focused on general enteral feeding practice and the management of feeding intolerance and complications.
The enteral feeding practice of critical care nurses varied widely and included some practices that could contribute to under-feeding in the critically ill. Practices associated with the measurement of gastric residual volumes (GRV) were identified as the most significant potential contributor to under-feeding. GRV measurements were commonly used to assess feeding tolerance (n = 338; 89.9%) and identified as a reason to delay feeding (n = 246; 65.4%). Delayed gastric emptying was frequently managed by prokinetic agents (n = 237; 63%) and decreasing the rate of feeding (n = 247; 65.7%) while nursing measures, such as changing patient position (n = 81; 21.5%) or checking tube placement (n = 94; 25%) were less frequently reported.
The findings of this survey support the contention that nursing practices associated with the delivery of enteral feeds may contribute to under-feeding in the critically ill patient population.
肠内营养是重症患者营养支持的首选方法；然而，这些患者中有相当一部分存在营养摄入不足的情况。尽管几乎没有数据描述该领域的护理实践，但与肠内营养输送相关的常见护理操作可能导致营养摄入不足。
采用基于描述性调查的设计，以探究376名重症监护护士的肠内营养实践（回复率为50.5%）。参与者完成了一项包含57个条目的调查，该调查聚焦于一般肠内营养实践以及喂养不耐受和并发症的管理。
重症监护护士的肠内营养实践差异很大，包括一些可能导致重症患者营养摄入不足的操作。与胃残余量（GRV）测量相关的操作被确定为营养摄入不足的最主要潜在因素。GRV测量常用于评估喂养耐受性（n = 338；89.9%），并被视为延迟喂养的一个原因（n = 246；65.4%）。胃排空延迟通常通过促动力药物处理（n = 237；63%）和降低喂养速度（n = 247；65.7%）来管理，而诸如改变患者体位（n = 81；21.5%）或检查管道位置（n = 94；25%）等护理措施的报告频率较低。
本次调查结果支持以下观点，即与肠内营养输送相关的护理操作可能导致重症患者营养摄入不足。
