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A survey of the enteral nutrition practices in patients with neurological disorders in the tertiary hospitals of China

中国三甲医院神经疾病患者肠内营养支持操作规范调查

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摘要


背景和目的:随着中国神经疾病营养支持工作的快速推进,相关指南已于2011年发表和推广。中华医学会肠外肠内营养学分会神经疾病营养学组在中国大城市展开调查,以评估神经疾病营养支持工作的现状。方法和研究设计:本研究为多中心前瞻性调查研究。调查资料来自2012年4月至2013年4月中华医学会肠外肠内营养分会神经疾病营养支持学组成员单位的18家医院。内容包括:神经疾病肠内营养支持基本条件(设备配置与人员配备)、接受肠内营养支持患者相关信息。结果:18家医院来自13个省市自治区,83.3%配置了肠内营养输注泵,77.8%具有经皮内镜下胃肠造瘘技术,88.9%配备临床营养支持小组。共调查404例成人患者(男性259人,女性145人;平均年龄为61.3±14.7岁),脑卒中占85.7%,意识障碍占83.9%,吞咽障碍占98%。在具体操作过程中,能量供给目标、营养输注方式和营养输注过程监测共3项操作规范的正确执行率偏低(56.2%,30%和38.9%);而其余7 项规范操作的正确执行率较高(均>75%)。结论:这项调查显示,中国三甲医院的肠内营养设备和人员配置是足够的。然而,一些相关的做法还没有达到所需的水平,提示该项工作需要进一步被理解和改进培训。

並列摘要


Background and Objectives: With the development of enteral nutrition in patients with neurological disorders in China, related guidelines were published in 2011. The Chinese Society for Parenteral and Enteral Nutrition conducted a survey to evaluate the status quo of enteral nutrition practices in these patients. Methods and Study Design: This multicenter prospective investigation was conducted from April 2012 to April 2013 and involved 18 tertiary hospitals in China. The survey using standardized questionnaires sought information about the basic protocols for enteral nutrition (devices and staffing) and specific information about patients with neurological conditions who received nutrition by way of enteral feeding. Results: In the 18 hospitals from 13 provinces, 83.3% patients were configured with an enteral nutrition infusion pump, 77.8% had a percutaneous endoscopic gastrostomy (PEG) device, and 88.9% had a clinical nutrition support group. Four hundred four patients participated in this survey (259 men, 145 women; mean age 61.3±14.7 years), 85.7% had suffered a stroke, 83.9% had impaired consciousness, and 98.0% had dysphagia. Of the 10 guidelines for enteral nutrition practices, setting the energy target, choosing the enteral nutrition tube, and monitoring the patient received unsatisfactory ratings were in poor compliance (56.2%, 30.0% and 38.9%, respectively); the remaining seven guidelines were in good compliance (each >75%). Conclusion: The survey suggested that configuration of the enteral nutritional devices and staffing was adequate in China’s tertiary hospitals. However, some associated practices had not yet reached the desired levels of competency, indicating a need for this to be understood and for improved training.

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