穿刺式空肠造口在肝移植术后早期肠内营养治疗中的应用和护理

总结11例肝移植患者经穿刺式空肠造口行术后早期肠内营养治疗的临床护理经验。对11例肝移植患者行术后早期经空肠造口肠内营养,术后均恢复顺利,未发生营养和护理并发症,肠功能恢复快,营养前后人体测量值无统计学差异（P〉0．05）。可见,肝移植患者经穿刺式空肠造口行术后早期肠内营养治疗是安全可靠的,细致的护理工作是保证治疗顺利进行的必要条件。     

晚期恶性梗阻性黄疸行肠内营养的护理

目的:探讨晚期恶性梗阻性黄疸患者应用经皮肝穿刺胆管引流联合经皮腔镜下空肠造口行肠内营养的护理方法。方法:总结12例行经皮肝穿刺胆管引流联合经皮腔镜下空肠造口肠内营养患者的护理方法,观察患者的护理效果。结果:12例患者经治疗后肝功能均明显好转,胆红素下降,白蛋白升高,电解质紊乱得到纠正,其中11例均经治疗后好转出院,能在家继续肠内营养治疗。结论:对晚期恶性梗阻性黄疸患者应用经经皮肝穿刺胆管引流联合经皮腔镜下空肠造口肠内营养等护理措施,保证治疗的顺利进行。     

食管癌根治术后经针刺导管空肠造瘘行肠内营养的护理

目的: 探讨Ivor-Lewis食管癌根治术后经针刺空肠造瘘行早期肠内营养的效果及护理体会。方法: 回顾性分析我院采用华瑞FKJ空肠造瘘装置在Ivor-Lewis食管癌根治术中行空肠造瘘术并早期行肠内营养的护理体会。结果: 22例手术均获成功,术中常规行针刺导管空肠造瘘。术后1例患者发生吻合口瘘,保守治疗后治愈出院。术后12-24小时空肠内造瘘管均顺利开放肠内营养,4-5天完全由肠内营养达到营养要求。结论:食管癌根治术中采用FKJ针刺导管性空肠造瘘,早期实行肠内营养简单,安全,值得临床广泛应用。良好的护理配合是手术达到最佳效果的重要保障。     

穿刺式空肠造口在腹部外科术后早期肠内营养治疗中的应用效果

目的探讨穿刺式空肠造口在腹部外科术后早期肠内营养治疗中的应用效果。方法选取本院腹部外科手术患者48例,术后早期采用穿刺式经空肠造口行肠内营养,观察术后营养状态及并发症发生率。结果患者术后均恢复顺利,未发生营养和护理相关并发症,肠功能恢复快,营养结束时人体测量值与术前比较有统计学差异(P0.05)。结论腹部外科手术患者经穿刺式空肠造口行术后早期肠内营养治疗是安全可靠的,而周密细致的护理工作是保证治疗顺利进行的必要条件,值得临床推广应用。     

全胃切除术后空肠造口肠内营养治疗的护理

目的：探讨全胃切除术后空肠造口肠内营养治疗的护理方法。方法：对12例全胃切除术后空肠造口肠内营养治疗的患者进行针对性的心理护理，输注过程中的精心护理，加强并发症的观察及处理。结果：治疗效果满意，无严重并发症发生。结论：空肠造口肠内营养治疗对护理要求高，但严密的观察和精心的护理可减少并发症的发生，提高肠内营养治疗效果。     

胃恶性肿瘤术后经空肠造口管早期肠内营养支持治疗疗效观察

目的探讨胃恶性肿瘤患者术后经空肠造口管早期肠内营养支持的可行性、安全性及并发症。方法回顾性分析83例胃恶性肿瘤手术患者,术中经腹壁空肠造口,术后第1天即给予肠内营养,直至术后第10天,观察术前1d及术后1,8d患者体质量、血浆白蛋白、血浆前白蛋白水平变化及术后肠道功能恢复、并发症等发生情况。结果本组空肠造口管放置时间3～6个月,患者均顺利完成肠内营养支持治疗;血浆白蛋白及前白蛋白水平在术后8d较术后1d明显升高(P<0.05),术后(49.1±15.5)h恢复肛门排气,2例出现吻合口瘘,经完全肠内营养治愈;无空肠造口相关并发症发生。结论胃恶性肿瘤患者术后经空肠造口管早期肠内营养安全、可行,并发症少,患者耐受性好,可有效改善其术后营养状况,有助于胃肠道功能的恢复。     

穿刺式空肠造瘘术在腹部大手术中的应用与护理

目的：探讨危重患者术后穿刺式空肠造瘘术肠内营养的护理经验。方法：对48例危重患者术中经空肠穿刺放置nocare可裂式空肠造瘘管（穿刺式空肠造瘘术），术后早期经造瘘管行肠内营养，观察患者肠内营养时胃肠道及造瘘管的并发症。结果：48例患者空肠造瘘管应用良好，4例患者发生导管阻塞，在介入引导下用导丝予以疏通后重新应用；穿刺处无红肿和炎性渗出及其他造瘘管相关发并症，均在7—28天内拔除造口管。结论：穿刺式空肠造瘘术可用于腹部大手术后患者早期肠内营养，心理护理、完善的营养计划、造瘘管的护理及观察营养时可能出现的并发症等良好细致的护理是成功实施肠内营养的保证。     

空肠造瘘营养管行肠内营养52例的护理

目的 探讨空肠造瘘营养管行肠内营养的临床护理方法.方法 对52例空肠造瘘行肠内营养的患者进行合理护理.结果 52例患者中发生轻微腹泻3例,较重腹泻1例,导管堵塞1例,无导管脱落发生;52例患者均康复出院.结论 对空肠造瘘行肠内营养的患者进行有效的护理是手术成功,患者顺利康复的基础.     

探讨胃癌术后早期肠内营养的方法及护理

目的:探讨胃癌术后患者进行早期肠内营养治疗的方法及其护理要点。方法:选取我科105例胃癌手术患者,术中经腹壁造口置入FRECA三腔喂养管,胃肠减压孔置于残胃或吻合口附近,空肠营养端置于屈氏韧带以远20cm空肠。术后6～8h开始滴入生理盐水及肠内营养液,循序渐进,经3d左右达到完全肠内营养。观察患者肠内营养相关并发症、疾病相关并发症、营养指标及肠蠕动恢复时间等情况。结果:105例患者均顺利完成手术及置管,在肠内营养期间未发生脱落,术后3d发生喂养管堵塞1例,予以拔除,其余104例患者顺利完成肠内营养治疗,其术后营养状态均得到有效改善,缩短了静脉营养时间及费用,促进了快速康复。结论:通过经腹壁造口安置的三腔喂养管进行胃癌术后早期肠内营养治疗,可以有效达到营养支持目的、避免其他营养治疗方法的并发症,并能促进患者快速康复。     

胃肿瘤术后空肠造瘘管和鼻空肠管行肠内营养的临床效果比较

目的：探讨胃肿瘤患者术后空肠造瘘管和鼻空肠管行肠内营养的临床效果。方法选取在我科行胃肿瘤手术的患者48例,按患者意愿分为鼻空肠管组（26例）和空肠造瘘组（22例）。两组患者均行心理护理、健康教育、空肠营养管护理、并发症防治、营养护理和口腔护理。比较两组患者意外脱管率、堵管率和置管时间。结果护理期间空肠造瘘组患者意外脱管率和堵管率均明显低于鼻空肠管组（圴P＜0．05）,平均置管时间显著长于鼻空肠管组（P＜0．01）。结论胃肿瘤患者术后空肠造瘘口与鼻空肠管比较行肠内营养可减少意外脱管发生率和堵管率,能够延长患者的置管时间。     

空肠造瘘用于肠内营养在危重症患者的护理进展华东医院 孙滨海 陈贞

临床营养支持根据输入途径的分为肠内营养和场外营养。其中肠内营养液输注是危重病患者营养支持中的重要途径。选择恰当的输入途径和输注方式是保证肠内营养顺利进行的重要条件。肠内营养分口服和管饲两种途径,后者包括鼻胃管、双腔胃-空肠管、空肠造瘘管、胃造瘘管、鼻十二指肠及鼻空肠管。由于鼻胃管的适用范围存在一定的局限性,因此不适于鼻胃管的患者在术中可置空肠造瘘管,以利于术后进行早期的肠内营养支持。现将空肠造瘘用于危重症患者肠内营养的国内外护理进展报告如下。     

重症急性胰腺炎术后营养支持的观察与护理

目的 探讨重症急性胰腺炎患者术后进行营养支持的观察与护理要点.方法 术后早期实施完全胃肠外营养,一旦患者胃肠功能恢复,血、尿淀粉酶正常,病情得以控制,就可由肠外营养向肠内营养过渡,尽早实施全肠内营养.观察营养指标及营养支持并发症.结果 10例患者实施营养支持后血总蛋白、白蛋白均高于营养支持前.营养支持期间,发生高血糖1例、胃返流1例、腹胀1例、腹泻2例、空肠造瘘管堵塞1例.以上均被及时发现和处理,无不良后果.未发生误吸.结论 重症急性胰腺炎患者术后进行营养支持可明显改善患者营养状况,护理工作中严密观察、预防和及时处理并发症是营养支持顺利实施的保证.     

Enteral nutrition: better navigation,yet unknown destination?

The nutrition dose truly absorbed by a patient is crucial information in the management or the investigation of nutrition during critical illness. In the present issue of Critical Care, assessment of nutritional losses in stools was studied. These losses together with enteral nutrition lost in gastric fluids and enteral nutrition prescribed but never infused make up the difference between the dose supposedly given to a patient and the amount effectively taken up. Additionally, the optimal dosing and timing of nutrition during critical illness are still debated. When enteral nutrition is insufficient, the options are limited.     

机械通气患者肠内营养支持的护理干预

通过加强监测和护理,减少机械通气患者行肠内营养支持时并发症的发生率。方法：将150例需行肠内营养支持的机械通气患者随机分成试验组和对照组各75例,试验组匀速输注营养液,并加强对常见并发症的重点监测和护理;对照组肠内营养支持采取一次性注入。结果：试验组肠内营养并发症发生率较对照组明显减少,保证了肠内营养安全有效地进行。结论：对机械通气患者行肠内营养支持时,加强重点环节的监测和护理,可减少并发症的发生、改善患者的营养状况,从而更有利于患者基础疾病的恢复。     

2例特发性胆道穿孔患儿术后早期序贯性肠内营养管理实践

总结2例特发性胆道穿孔患儿术后实施早期序贯性肠内营养的护理经验。护理要点：组建营养管理团队,重视营养风险筛查及营养评估,制订个体化肠外营养方案,启动早期序贯性肠内营养,并加强喂养耐受性评估；实施自体消化液回输；加强胃造瘘的护理；开展家庭肠内营养指导及延续性护理等。经过精心治疗和护理,2例患儿的营养状况均明显改善,好转出院。出院后6个月随访,生长发育正常。     

Nutrition of the critically ill patient and effects of implementing a nutritional support algorithm in ICU

Aim. To test whether a feeding algorithm could improve the nutritional support of intensive care patients. Background. Numerous factors may impede delivery of both enteral and parenteral nutrition to patients in the intensive care unit. Often there is a discrepancy between what is prescribed and actual delivery of nutrients. The purpose of this study was to test the effect of a nutritional support algorithm in an intensive care unit mainly by using the enteral route and if necessary by combining enteral and parenteral nutrition. Methods. In this prospective study, nutritional data were collected from routinely fed critically ill patients (controls, n = 21) during the first three days following admission to the intensive care unit. A nutritional support algorithm was then implemented and nutritional data were collected from critically ill patients who participated in this intervention (intervention group, n = 21). Data collected included the total amount of calories prescribed vs. received, onset of delivery of enteral nutrition, enteral vs. parenteral nutrition, and the use and size of enteral feeding tubes. Results. Patients in the intervention group were both prescribed and actually received significantly larger amounts of nutrients than patients in the control group. They also received a larger proportion of their nutrients in the form of enteral nutrition. In addition, the nutritional support algorithm led to greater consistency in nursing practices with respect to aspiration of gastric content and rate of increment in enteral feeding. Conclusion. The study confirms that a nutritional support algorithm improved the delivery of nutrients to critically ill patients. The algorithm was most effective with respect to the delivery of enteral nutrition. The effect was primarily because of early and more rapid increment in the delivery of enteral nutrition administered by nurses based on improved physician orders. The combination of enteral and parenteral nutrition may contribute to meeting adequate nutritional requirements. Relevance to clinical practice. By using a nutritional algorithm focused on enteral nutrition, but including parenteral nutrition as a supplement, it is possible to improve the delivery of clinical nutrition in the intensive care unit patients.     

Is it now time to promote mixed enteral and parenteral nutrition for the critically ill patient?

Background Intensive care outcome measured by morbidity and mortality is altered in the severely malnourished ICU patient, and nutritional support of the critically ill is accepted as a standard of care. Current recommendations suggest starting enteral feeding as soon as possible whenever the gastrointestinal tract is functioning. The disadvantage of enteral support is that inadequate energy and protein intake can occur. The present commentary focuses on some recent findings regarding the nutritional support of critically ill patients and proposes to promote mixed nutrition support by enteral nutrition (EN), and by parenteral nutrition (PN) whenever EN is insufficient. Recent findings An increasing nutrition deficit during a long ICU stay is associated with increased morbidity (increased infection rate or impaired wound healing). Evidence shows that EN can result in underfeeding and that nutrition goals are reached only after 5–7 days. Contrary to former beliefs, recent meta-analyses of studies in the ICU showed that PN is not related to excess mortality but may even be associated with improved survival. Conclusions Optimising the increased substrate requirement for the critically ill by initiating timely nutrition support and ensuring tight glycaemic control with insulin is now considered central for improved intensive care outcomes. Supplemental PN combined with EN could be an effective alternative to achieve 100% of energy and protein targets at day 4, when EN alone fails to achieve goals greater than 60% by day 3. Whether such combined nutrition support provides additional benefit on overall outcome has to be ascertained in further studies.     

Outcome of direct percutaneous endoscopic jejunostomy tube placement for nutritional support in critically ill, mechanically ventilated patients

Purpose: Gastrointestinal function is adversely affected in critically ill mechanically ventilated patients. The most common abnormality is delayed gastric emptying. Among the options for postpyloric feeds, direct percutaneous endoscopic jejunostomy (PEJ) provides a permanent, reliable, and direct access to the small bowel and can be used for full enteral feedings, thus eliminating the need for parenteral nutrition. Patients and Methods: All patients who underwent direct PEJ tube placement while mechanically ventilated in the intensive care unit (ICU) were evaluated. For each patient the following factors were identified: age, indication for ICU admission and PEJ placement, nutritional support before and after PEJ placement, calories received, complications, and outcome. Results: Seventeen patients underwent the procedure. All had successful placement of direct PEJ tube. There was a single complication. Within 24 hours of PEJ placement, 16 of 17 patients tolerated jejunal feedings. All patients progressed to their established nutritional goals. There were no cases of aspiration of enteral feedings. In the 16 patients, total parenteral nutrition (TPN) was not required once PEJ tubes were placed. Thirteen patients were discharged home or to a rehabilitation facility with jejunal feedings. Conclusions: Direct PEJ placement is a safe and reliable device that can be successfully placed in critically ill, mechanically ventilated patients. With this procedure, all patients can meet their nutritional requirements and eliminate the need for TPN. Copyright © 2002 by W.B. Saunders Company     

A European survey of enteral nutrition practices and procedures in adult intensive care units

Aims. The aim of this survey was to gain an overview of enteral nutrition practices and procedures of European adult intensive care units and to describe current trends. Background. Currently, little is known about nutritional practices in European intensive care units and whether they match existing guidelines. Design. Survey. Methods. A 51‐item questionnaire about nutritional assessment and enteral feeding was distributed to 383 intensive care units in 20 countries. Results. A total of 380 (99·2%) questionnaires were returned. Most intensive care units (86·5%, n = 320/370) did not use a nutritional risk score and 35·8% (n = 133/371) conducted daily assessments of nutritional status; body weight and serum albumin were the commonest measures. Checking the position of the feeding tube using auscultation of injected air was widespread (72·6%, n = 275/373). Most units used a clinical protocol and under half were supported by a nutritional support team. Conclusion. There are some variations in enteral nutrition practices across European intensive care units. Involvement of nurses in performing nutritional assessments or developing clinical protocols was minimal. The use of outdated procedures for checking feeding tube placement is a concern. There is scope for further development of nutrition guidelines in European units. Relevance to clinical practice. This study is relevant to all nurses working in critical care areas. The findings suggest that when an intensive care unit is supported by a nutritional support team it is more likely that a nutritional score will be used and nutritional assessments will be made daily. Many intensive care practices do not conform to international guidelines for enteral feeding. Nutritional assessment and the use of nutritional risk scores are areas that would benefit from further application in intensive care. This study may provide an impetus for intensive care units to review their nutrition assessment practices and to advance evidence‐based guidelines, developed by multi‐professional teams, which ensure the safe and effective management of patients receiving enteral nutrition.     

72例使用肠内营养输注泵患者的护理

总结了72例使用肠内营养输注泵患者的护理,护理要点包括:重视营养评估及心理护理,规范肠内营养流程和输注泵的使用,及时处理并发症,避免安全隐患,同时做好患者活动、睡眠的护理和健康指导。本组1例放弃治疗,1例不能耐受置管及胃肠道反应改用肠外营养,50例出现胃肠道反应经治疗后好转,20例未诉不适。