机械通气病人肠内营养相关性呕吐预防及管理方案的构建与应用OA

Objective:To construct an evidence-based prevention and management protocol for enteral nutrition-associated vomiting in mechanically ventilated patients,and to evaluate its clinical application effectiveness.Methods:The prevention and management protocol was constructed through systematic literature search,evidence summary,Delphi method,and a pre-trial.Convenience sampling method was employed to select 107 patients undergoing enteral nutrition therapy with mechanical ventilation in the respiratory intensive care unit of a tertiary grade A hospital in Wuhan city as the research subjects.They were divided into a control group of 53 cases and a test group of 54 cases according to their admission time.The control group received routine nursing care,while the test group received enteral nutrition-associated vomiting prevention and management protocol for mechanically ventilated patients.The incidence of enteral nutrition-associated vomiting,the achievement rate of target caloric intake,serum biochemical indicators,as well as nurses'knowledge level regarding nursing care for enteral nutrition-associated vomiting in mechanically ventilated patients before and after protocol implementation were compared between the two groups.Results:The constructed prevention and management protocol for enteral nutrition-associated vomiting in mechanically ventilated patients consisted of 3 dimensions,8 categories and 20 specific measures.The incidence of enteral nutrition-associated vomiting,the rate of target caloric attainment on the seventh day after intervention,and hemoglobin concentration in the test group were all superior to those in the control group(P<0.05).Nurses'knowledge level regarding enteral nutrition-associated vomiting in mechanically ventilated patients increased after the protocol implementation(P<0.05).Conclusions:The constructed prevention and management protocol for enteral nutrition-associated vomiting in mechanically ventilated patients contains 3 dimensions,8 categories and 20 specific measures.It has scientificity and practicability.It could effectively reduce the risk of enteral nutrition-associated vomiting,improve the early nutritional status of mechanically ventilated patients,and provide reference for clinical medical staff in the practice of enteral nutrition.