提升重症病人72小時內腸道灌食理想熱量達成率之改善專案

Project to Attain the Ideal Caloric Intake Level in Critical Patients within a 72-Hour Period

黃素芬(Su-Fen Huang) ； 楊琳琪(Lin-Chi Yang) ； 邵學方(Hseu-Fang Shao) ； 許正義(Jane-Yi Hsu) ； 吳杏真(Hsing-Chen Wu)

《護理雜誌》 61卷2期附冊 (2014/04) Pp. 5-13

https://doi.org/10.6224/JN.61.2S.5

摘要

背景　早期提供重症病人腸道灌食並於72小時內達目標熱量之70%，可降低院內感染、住院天數與死亡率。本單位重症病人之理想熱量達成率較低（40.6%）。目的　透過專案的執行，使重症病人72小時內理想熱量達成率提升至70%。解決方案　（1）舉辦營養相關在職教育、（2）制定腸道灌食流程表、宣導並鼓勵執行腸道灌食流程表、（3）與醫師及營養師共同討論病人灌食狀況、（4）修訂重症病人鼻胃管灌食標準流程等。結果　理想熱量達成率由40.6%提升至74.3%。結論　此專案透過跨團隊合作，確實可提高重症病人之理想熱量達成率。可提供未來其他醫院改善重症病人理想熱量之參考，以改善醫療照護品質。

關鍵字

重症病人 ； 腸胃道灌食 ； 理想熱量達成率

並列摘要

Background & Problems: Early enteral nutrition and receiving more than 70% of the ideal caloric intake level has been shown to reduce patient infection rates, duration of hospital stays, and mortality. Only 40.6% of patients in our surgical intensive care unit were achieving the ideal caloric intake level.Purpose: This project was designed to raise the ratio of those achieving an ideal caloric intake level from 40.6% to 70%.Resolutions: Strategies included: (1) providing education related to nutrition, (2) establishing an enteral nutrition flowchart and popularizing and carrying out the enteral nutrition flowchart, (3) discussing together with doctors and nutritionists about feeding conditions, and (4) revising standard procedures for the NG feeding of critical patients.Results: Seventy percent of patients in the surgical intensive care unit achieved their ideal caloric intake level after implementation of this intervention.Conclusions: This project used interdisciplinary cooperation to improve caloric intake among patients in the surgical intensive care unit. The intervention and results may be used as a reference by hospitals for improving patient caloric intake and hospital quality of care.

並列關鍵字

critical patients ； enteral nutrition ； ideal caloric intake

參考文獻

林晏如、陳玉如、葉玲岑、李靜怡、王秀媛（2011）．早 期腸道營養對內科重症老人預後之探討．重症醫學 雜誌，12（1），1－ 8。[Lin, Y. J., Chen, Y. J., Yeh, L. T., Lee, C. Y., & Wang, H. Y. (2011). Enteral nutrition on critical outcomes in medical critically ill geriatric patients. Taiwan Critical Care Medicine, 12(1), 1－ 8.]

翁敏雪（2007）．重症病人的營養照護．長庚護理，18 (3)， 365－ 371。[Weng, M. H. (2007). Nutritional support and nursing care for critically illed patients. Chang Gung Nursing, 18(3), 365－ 371.]

王義明、黃煜為、林姿伶、陳思穎（2009）．重症病患的營 養支持．重症醫學雜誌，10（3），229－ 241。[Wang, Y. M., Huang, Y. W., Lin, T. L., & Chen, S. Y. (2009). Nutrition support in critical care. Taiwan Critical Care Medicine, 10(3), 229－ 241.]

Arabi, Y., Haddad, S., Sakkijha, M., & Shimemeri, A. A. (2004). The impact of implementing an enteral tube feeding protocol on caloric and protein delivery in intensive card unit patients. Nutrition in Clinical Practice, 19(5), 523－530. doi:10.1177/0115426504019005523

Artinian, V., Krayem, H., & DiGioyine, B. (2006). Effects of early enteral feeding on the outcome of critically mechanically ventilated medical patients. Chest, 129(4), 960－967. doi:10.1378/chest.129.4.960