重症病人腸道營養給法標準之建立

The Development of a Standard Protocol for Effective and Safe Administration of Enteral Nutrition

邱艶芬(Yann-Fen C. Chao)

《慈濟醫學雜誌》 6卷3期 (1994/09) Pp. 185-202

https://doi.org/10.6440/TZUCMJ.199409.0185

摘要

本研究即在探討重症病人自腸道排取營養之能力，找出有意義且方便使用之指頁，以依循指標決定管餵灌食的措施，建立適當管餵方法的標準。本研究自教學醫學加護病房100位個案所提共448觀察，分析歸納對各腸對各腸道營養適應情形的影響具有統計上意義的因素。研究結果發現影響胃殘餘量的決定因素為：疾病嚴重度與灌食液腫類：影響腸音的決定因素為：疾病嚴重程度、灌食速度、與水腫；影響腹脹的決定因慌為：禁食日數與灌食液滲透壓；而影響腹瀉的決定因素為：灌食液滲透壓、淋巴球總數、灌食液種類、用藥、理想體重百分比、與血鉀值。本研究依居分析結果，提出腸胃營養給法的建議：胃殘餘量方面於疾病嚴重程度(APACHE II分數)高者，宜考慮小量清淡軟食，且密切偵測胃殘餘量，並小心預防嘔吐吸入之狀況；於腸蠕動方面，因灌食速度會刺激腸蠕動，並不致於使解水便的機會增加，臨床人員在照顧因重病引起腸塞絞的病人時，可藉著灌食速度的調節，促進腸蠕動；在腹脹方面，對於禁食日數超過三天以上者，為促進胃腸對管餵措施的適應，採取促進腸蠕動的方法(如藥物)有其實際上的意義；至於腹瀉，為減少病患發生腹瀉現象，必須評估病人的營養狀況、血鉀與用藥，調整灌食液處方。(慈濟醫1994; 6: 185-202)

關鍵字

腸道營養 ； 胃殘餘量 ； 腹瀉 ； 重症病人

並列摘要

The purpose of this study was to identify predictive indices for the gastrointestinal tolerance of critically ill patients in order to guide safe and efficient administering of enteral nutrition. One hundred adults admitted to ICUs of two teaching hospitals during the year of 1992 were included in this study. A total of 448 observations were yielded for data analysis. The result indicated that the determinants of gastric residual were: severity of illness (as measured by APACHE II score) and types of feeding formula; the determinants of bowel sound were: severity of illness, feeding sped, and the presence of edema; the determinants of abdominal distension were: days on NPO restriction and formula osmolality; the determinants of diarrhea were: formula osmolality, total lymphocyte counts, type of feeding formula, usage of drugs, percentages of ideal body weight, and serum potassium levels. The proposed intervention for prevention and mamagement of above GI intolerant problems were: in patients with APACHE II score higher than 20, use of clear diet and feeding at slow speed to avoid large amount of gastric residual; high feeding speed may be beneficial to ileus patients to improve bowel movement and would not contribute to diarrhea; usage of medicine promoting bowel movement may be necessary for patients on NPOrestriction for more than 3 days; for better management of diarrhea problem, adjusting feeding regimen according to patient’s nutritional status, serum potassium levels, and cocommitant medicines would be essential. (Tzu-Chi Med J 1994; 6: 185-202)

並列關鍵字

enteral nutrition ； gastrointestinal intolerance problem ； critically ill patients