营养支持实践及对小儿骨髓移植中心胃造口术使用的看法：一项全国性调查。
Nutritional support practices and opinions toward gastrostomy use in pediatric bone marrow transplant centers: A national survey.
机构信息
Dietetics Department, Great Ormond Street Hospital for Children, London, UK; University College London Great Ormond Street Institute of Child Health, UK.
Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, UK.
出版信息
Nutrition. 2022 Mar;95:111556. doi: 10.1016/j.nut.2021.111556. Epub 2021 Nov 27.
OBJECTIVE
Previous surveys have shown deviations in nutritional practices from international guidelines during bone marrow transplant (BMT). Guidelines recommend enteral nutrition first-line and nasogastric tubes are the mainstay for its provision. Gastrostomies provide an alternative, yet their use is less common. This national survey investigated nutrition support practices in pediatric allogeneic BMT centers and compared clinicians' opinions on gastrostomy use. The aim of this study was to identify the national picture of nutritional support practices across pediatric allogeneic BMT centers, including use and opinions of dietitians, clinical nurse specialists, and physicians, toward gastrostomy feeding.
METHODS
An online survey was administered to 12 centers. The lead dietitian answered questions regarding nutritional counseling, screening, assessment, and interventions. Questions regarding current use, perceived advantages, and problems of gastrostomies were answered by the dietitian, lead clinical nurse specialist, and physician.
RESULTS
A 100% response rate was achieved from 12 centers (N = 36 clinicians). Nutritional counseling was provided in 92% of centers before and routinely throughout admission, 83% screened on and regularly throughout admission, 83% assessed nutritional status before transplant, and 92% used enteral nutrition first-line. Forty-two percent of the centers used gastrostomies. In those not using gastrostomies, 76% of clinicians felt some children should be offered a gastrostomy. Clinicians perceived less displacements (78%) and cosmetic appearance (69%) as the most common advantages of gastrostomies over nasogastric tubes. Risks associated with surgery (92%) and tube/stoma complications (58%) were the most common perceived problems.
CONCLUSIONS
A similar approach was shown on many aspects of nutritional support. Gastrostomy use divided opinion with differences in use and perceived advantages, but agreement on potential complications. Despite their risks, clinicians wanted to use gastrostomies more. Placement requires careful consideration of the risks, benefits, and family preferences.
目的
先前的调查显示，骨髓移植（BMT）期间营养实践与国际指南存在偏差。指南建议首先采用肠内营养，鼻胃管是其主要提供方式。胃造口术提供了一种替代方法，但使用较少。这项全国性调查研究了儿科异基因 BMT 中心的营养支持实践，并比较了临床医生对胃造口术使用的意见。本研究的目的是确定儿科异基因 BMT 中心营养支持实践的全国情况，包括营养师、临床护士专家和医生对胃造口喂养的使用和意见。
方法
对 12 个中心进行了在线调查。首席营养师回答了关于营养咨询、筛查、评估和干预的问题。营养师、首席临床护士专家和医生回答了关于胃造口术当前使用、感知优势和问题的问题。
结果
12 个中心（N=36 名临床医生）的回复率达到了 100%。92%的中心在入院前和住院期间提供营养咨询，83%的中心在入院期间进行筛查，83%的中心在移植前评估营养状况，92%的中心首先采用肠内营养。42%的中心使用胃造口术。在未使用胃造口术的中心中，76%的临床医生认为一些儿童应该接受胃造口术。临床医生认为胃造口术比鼻胃管具有更少的移位（78%）和外观（69%）优势。手术相关风险（92%）和管/造口并发症（58%）是最常见的感知问题。
结论
在营养支持的许多方面都表现出类似的方法。胃造口术的使用存在分歧，使用和感知优势不同，但对潜在并发症的看法一致。尽管存在风险，临床医生还是希望更多地使用胃造口术。放置需要仔细考虑风险、益处和家庭偏好。
Zotero 插件