危重病人肠内营养耐受性分级及管理.pptVIP

＆将静脉、口服、特殊药物的特殊事项作为重点掌握，并且 结合临床实践共同分享病例文献； ＆收集现有科室使用的相关药物，将临床口服用药特殊剂型 鼻饲注意事项编译在肠内营养知识手册中; ＆促使护理人员在鼻饲药物时掌握药物的剂型、药物的理化 特性，根据药物性质决定鼻饲时机； ＆鼻饲使用后冲洗导管；避免药物和肠内营养液混合； 给药护理 ＆近年来的研究对于在重症监护病房实施抽吸胃残留以监测 EN有较大分歧； ＆有呕吐、误吸等风险的高危患者中每4-6h 抽吸一次胃残留， 密切观察其他症状，结合床头抬高、实施口腔护理、适时调 整喂养速度等降低吸入性肺炎的发生； ＆认真解读相关指南的基础上，穿插国内外相关文章； 胃残留抽吸护理 指南推荐：胃内残余量＜500ml并且没有其他不耐受的表现时不应终止肠内营养（B级） 胃潴留量（GRVs)评估胃动力 Page 3 – Complications After survival the most relevant question is how many complications occur and how can they be reduced. Enteral nutrition was shown to be significantly better than parenteral nutrition in this important outcome parameter. When looking specifically at hyperglycaemia, the study by Koretz showed that this metabolic complication was significantly reduced by 30% in critically ill patients - an impressive number. The meta-analysis by Peter encompassed 24 studies. These studies reported numbers of patient experiencing infective complications (not further specified). As you can see from the forest plot, most of the blue dots are on the right side, meaning the result favours enteral nutrition. And this is also statistically shown in the overall result where the diamond is clearly on the right side; it is not touching the neutrality line and therefore represents a significant result. The extent of this risk reduction can also be seen in the forest plot: 8% less complications were developed in this group when compared with the parenteral group. In the analysis by Koretz where only critically ill patients were included the reduction of infective complications was 9% when enteral nutrition was used. In addition to the infective complications reported above, Peter also analyzed the non-infective complications. The result was that enteral nutrition again significantly reduced these complications by 5% (most pronounced in the medical group). It might be obvious – but still