摘要
目的 通过调查了解河北省重症患者营养支持治疗现状,找出存在的问题及不足,以规范和促进我省重症患者营养支持治疗及其发展.方法 采用横断面调查法,通过自制问卷对河北省20家三级医院的重症医学科2013年6月5日215例住院患者进行营养调查,并对调查结果进行统计、分析.结果 所有重症医学科均参考＂营养支持指南＂作为营养支持方案.多数（85%）重症医学科对床头抬高和监测胃残余量均有明确规定.做营养风险评估的占65%,指标主要为血清白蛋白、血清前白蛋白和体质量指数,大多以20～25kcal·kg-1·d-1（40%）和25～30kcal·kg-1·d-1（40%）计算以确定每日提供热量;鼻空肠管由ICU护士（40%）和内镜医师（35%）留置,半数（50%）重症医学科通过X线判断鼻空肠管位置,也有应用注空气时听诊法（25%）判断,营养医嘱主要由ICU医师（95%）管理,60%重症医学科由护士调节营养速度.主要由ICU医师（70%）调节胰岛素用量,血糖高限为9～11mmol/L,血糖低限多为4～6mmol/L.结论 河北省重症患者营养支持治疗逐渐得到重视并趋于规范,应进一步加强营养风险评估,参考营养指南,结合患者具体情况实行个体化营养支持治疗,使患者最大获益.
Objective The aim of this study was to investigate the current status of nutrition support to critical ill pa- tients in Hebei province, finding out the problems and shortcomings,in order to regulate and improve the present state of nutri- tion therapy in critically ill patients and its development. Methods A cross-sectional survey of nutrition practices in 215 ad- mitted patients from 20 intensive care units of tertiary hospital was conducted on June 5,2013. A database of information col- lected by self-administered questionnaires was established and the results of the survey were analyzed. Results ＂Nutrition support guideline＂ was applied to all the ICUs. The head of bed elevation and monitoring of gastric residual volume were as- sessed in most ICU （85 % ）. Nutritional risk assessment accounted for 65 % , through monitoring of the serum albumin, prealbu- min and body mass index. Studies suggested that achieving targeted calorie intake calculating by 20 N 25kca1/kg/d （40%） and 25 N 30kcal/kg/d （40%） may he sufficient. Nasointestinal tube was deposited by nurses of ICU （40%） and endoscopic doc- tor （ 35 % ）. X-ray （ 50% ） and stethoseopy （ 25 % ） could be used to judge the position of the nasointestinal tube. ICU physicians （95 % ） were in charge of nutrition program and nutritional speed was regulated by ICU nurses （60%）. Insulin dosage was ad- justed mainly by the ICU physicians （70%）, with blood glucose ranged from 9 - 1 lmmol/L to 4 - 6mmol/L. Conclusion Nutrition support therapy to critical ill patients in Hebei province has been paid great attention and made it standardization gradually. However,we cannot emphasize the significance of nutrition risk assessment. Combining guildlines with individualized nutrition suppot therapy will benefit for the critical ill Patients.
出处
《临床合理用药杂志》
2013年第35期30-32,共3页
Chinese Journal of Clinical Rational Drug Use
关键词
营养支持
横断面调查
重症医学科
危重症
Nutritional support
Cross-sectional studies
Intensive care units
Critical illness
