老年卒中患者肠内营养不耐受的循证护理

目的探讨肠内营养不耐受的老年脑卒中患者的循证护理依据。方法依据PICO原则和患者情况，提出个性化的临床问题，计算机检索NGC、DARE、CDSR、CCRT、MEDI。INE和CBM，收集处理肠内营养不耐受（呕吐）护理措施的临床证据。结果最终共纳入2篇临床实践指南、1个meta分析和3个RCT。根据最终检索结果、患者病情和患者及家属意愿，采用匀速恒温定时输注营养制剂、控制血糖、使用胃动力药、更换营养制剂配方以及肠外营养辅助的综合护理治疗。结论针对病情复杂的老年脑卒中患者的营养支持采用循证医学的方法，可为患者提供既科学又个体化的护理。

Evidence-based and individualized nursing practice for elder stroke patient with enteral nutrition intolerance

Objective To provide evidence-based therapeutic schedule for an elder stroke patient vomiting when was undergoing enteral nutrition. Method The personalized clinical questions were put forward based on the PICO and patient＇s condition, and the following databases such as NGC, The Cochrane Library of DARE, CDSR, CCTR, PubMed and CBM were searched to collect the best clinical evidences of improving the feeding tolerance for preven- ting vomit. Result Two clinical guidelines, one systematic review and three randomized controlled trials were includ- ed finally. According to the retrieval outcomes, patient＇s clinical condition, and patients and their family members＇ willingness, a reasonable nursing plan of EN was formulated., provide nutrition preparation regularly in a uniform speed with optimum temperature, monitor gastric residual volume, control blood sugar, use Prokinetic drug, change enteral nutition formula,and apply parenteral nutrition for adjuvant treatment. By implementing these nursing meas- urements,the patient developed a better gastrointestinal tolerance, did not vomit any more, and increased the nutri- tional intake. Conclusion Evidence-based approaches are helpful to provide a nursing plan that meets the needs of both scientific calness and individualization to elder stroke patient s who need nutrition support