摘要
目的了解危重患者肠内营养期间床头抬高的实施现状,为制定减少肠内营养并发症的有效措施提供依据。方法借鉴美国危重症护理学会床头抬高依从性调查工具表,对26例行鼻胃管肠内营养患者从5个不同时间点(8:00、10:00、12:00、14:00、16:00)对床头抬高角度进行测量。结果测量730例次,床头抬高平均角度为(15.85±6.06)°,床头抬高≥30°仅32例次(4.38%)。不同时间点、机械通气与否,Braden评分、APACHE-Ⅱ评分高低的患者床头抬高角度比较,差异有统计学意义(P<0.05,P<0.01),且Braden评分、APACHE-Ⅱ评分与床头抬高存在相关性(均P<0.01)。结论 ICU患者使用肠内营养期间床头抬高30°的落实情况不佳,护士对患者病情及压疮危险的考虑均影响这一措施的执行。临床工作中应全面考虑患者体位与病情要求,权衡风险和利弊,采用综合性的干预措施,以降低这些因素对体位护理的限制,从而减少肠内营养并发症。
Objective To explore ICU nurses′ implementation of elevating head-of-bed（HOB） for critically ill patients receiving enteral nutrition（EN）,and to provide implications for nurses to reduce EN complications.Methods Data regarding HOB positioning at 5 time points of 8：00,10：00,12：00,14：00,and 16：00 in 26 critically ill patients receiving EN therapy were collected according to PART-Ⅰof Ventilator Associated Pneumonia Audit Tool（AACN）.Results HOB positioning in the 26 critically ill patients were measured 730 times in day shift.The average degrees of HOB was（15.85±6.06）°.Only 32 times（4.38%） of measurement were found to have HOB greater than 30°.Degrees of HOB were found to be significantly different at different time points;patients with mechanical ventilation or not,and patients with different scores of Braden scale and APACHE-Ⅱ,had significantly different degrees of HOB（P0.05,P0.01）.Scores of Braden scale and APACHE-Ⅱ were correlated with degrees of HOB（P0.01 for both）.Conclusion For critically ill patients receiving EN,nurses fail to raise the HOB to 30° as a result of their worry of patients′ condition and possible risk of pressure ulcer.Nurses should take patients′ position and their condition into account,weigh the pros and cons,and take comprehensive interventions in an attempt to reduce the limit of these factors on the HOB positioning and reduce EN complications.
关键词
危重患者
肠内营养
床头抬高
体位护理
critically ill patients
enteral nutrition
raising of head-of-bed
care of body positioning
