以护士为主导的成人肠内营养患者鼻胃管喂养最佳证据总结

蒋明瑾; 林颖; 姜颖; 徐俐

doi:10.16766/j.cnki.issn.1674-4152.004394

以护士为主导的成人肠内营养患者鼻胃管喂养最佳证据总结

doi: 10.16766/j.cnki.issn.1674-4152.004394

蒋明瑾¹,
林颖²,
姜颖¹,
徐俐^3, ,

1.
上海中医药大学附属市中医医院外科，上海 200071
2.
上海中医药大学附属市中医医院急诊病房
3.
上海中医药大学附属市中医医院护理部

基金项目:

上海医学创新发展基金会中医药科技发展项目 WL-HLPY-2021002k

详细信息

通讯作者:
徐俐，E-mail：wwh_home@163.com

中图分类号: R459.3 R473.5
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- 文章访问数: 4
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- 被引次数: 0
出版历程
- 收稿日期: 2025-03-30
- 网络出版日期: 2026-04-11

Best evidence summary of nurse-led nasogastric tube feeding in adult patients receiving enteral nutrition

1.
Department of Surgery, Shanghai Municipal Hosptial of Traditional Chinese Medicine, Shanghai University of Tradition Chinese Medicine, Shanghai 200071, China

摘要

摘要: 目的全面检索、评价和整合以护士为主导的成人鼻胃管喂养护理最佳证据，为护理人员执行鼻饲护理循证实践提供理论依据。方法基于“6S”证据模型，系统检索国内外相关文献，中文数据库包括中国知网、万方、维普、医脉通指南网、丁香园、CBM等；英文数据库包括BMJ、Up To Date、JBI、PubMed、Cochrane Library、ASPEN、ESPEN、BAPEN、AGA等营养学会、GIN、NGC、NICE等，检索时限从建库至2023年9月。结果最终纳入7篇指南、2篇临床决策报告、1篇专家共识和4篇系统评价，共计14篇文献，汇总整合形成9个主题、21条证据。主题包括组织与管理、评估与筛查、喂养启动前、喂养执行流程、喂养监测、中医护理、喂养设备管理、喂养终止时机及健康教育。结论本研究汇总整合以护士为主导的鼻胃管喂养最佳证据，为临床护理人员提供了基于循证的、完整的鼻胃管喂养执行证据，应用人员需结合临床情境，提高护理人员循证实践能力，针对性地进行证据运用，以提高鼻饲护理质量，改善患者营养状况及预后。
- 肠内营养 /
- 鼻胃管喂养 /
- 循证护理 /
- 证据总结
Abstract: Objective To comprehensively search, evaluate, and integrate the best evidence for nurse-led adult nasogastric tube feeding care, providing a theoretical basis for evidence-based practice in nasogastric feeding care for nursing staff. Methods Based on the "6S" evidence model, a systematic search was conducted on relevant guideline websites and databases both domestically and internationally. Chinese databases included: China Biology Medicine disc, CNKI, Wanfang, VIP, Yimai Guide Network, and DXY. English databases included: BMJ, Up To Date, JBI, PubMed, Cochrane Library, ASPEN, ESPEN, BAPEN, AGA nutrition societies, GIN, NGC, NICE, and so on. The search period was from the establishment of the databases to September 2023. Results A total of 14 articles were included, consisting of 7 guidelines, 2 clinical decisions, 1 expert consensus, and 4 systematic reviews. Nine themes were summarized and integrated, totaling 21 pieces of evidence, including organization and management, assessment and screening, pre-feeding preparation, feeding implementation procedures, feeding monitoring, traditional Chinese medicine nursing, feeding equipment management, feeding termination criteria, and health education. Conclusion This study summarized and integrated the best evidence for nurse-led nasogastric tube feeding for patients requiring enteral nutrition, providing clinical nursing staff with an evidence-based, comprehensive nasogastric feeding operational process. Practitioners should combine the evidence with clinical context, enhance the evidence-based practice capabilities of nursing staff, and selectively apply the best evidence to improve the quality of nasogastric feeding care and patient nutritional status and outcomes.
- Enteral nutrition /
- Nasogastric tube feeding /
- Evidence-based nursing /
- Evidence summary

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图 1 文献筛选流程

Figure 1. Literature screening process

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表 1 纳入文献的一般特征

Table 1. General characteristics of included literature

纳入文献	发表年份	文献主题	文献来源	文献类型
NICE^[15]	2017	成人营养支持治疗	PubMed	指南
BOULLATA J I^[16]	2016	EN安全治疗规范	PubMed	指南
COMPHER C^[17]	2021	成人危重患者肠内和肠外营养指南	NGC	指南
MCCLAVE S A^[18]	2016	成人住院患者营养支持治疗指南	GIN	指南
REINTAM B A^[19]	2017	成人住院患者早期肠内营养指南	PubMed	指南
UKLEJA A^[20]	2018	成人住院患者营养支持标准	PubMed	指南
胡延秋^[21]	2016	成人经鼻胃管喂养临床实践指南	CNKI	指南
米元元^[22]	2021	危重症患者EN常见并发症预防管理专家共识	丁香园	专家共识
GLEN K^[23]	2021	PH测定对NGT喂养前位置确认的安全性及有效性	PubMed	系统评价
OSLAND E J^[24]	2020	EN患者喂养设备循环使用证据总结	PubMed	系统评价
SANTOS S C^[25]	2016	EN患者NGT置入深度预测	PubMed	系统评价
WANG J^[26]	2022	腹部按摩对EN患者喂养不耐受的影响	PubMed	系统评价
DAVID S M^[27]	2023	经胃与幽门肠内营养支持概述	Up To Date	最佳实践
RICHARD A H^[28]	2023	成人住院患者NGT放置及管理	Up To Date	最佳实践

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表 2 纳入指南的质量评价

Table 2. Quality assessment of included guidelines

纳入文献	范围和目的	参与人员	严谨性	清晰性	适用性	独立性	总体质量
NICE^[15]	90.48	85.71	89.28	82.14	85.71	64.20	A
BOULLATA J I^[16]	80.95	75.00	90.48	85.71	78.57	85.71	A
COMPHER C^[17]	92.86	89.28	85.71	92.80	75.00	67.80	A
MCCLAVE S A^[18]	89.28	75.00	77.14	89.20	89.28	85.71	A
REINTAM B A^[19]	82.14	67.85	53.57	71.43	78.57	45.71	B
UKLEJA A^[20]	88.89	86.11	75.00	86.11	64.58	83.33	A
胡延秋^[21]	82.14	76.69	89.28	90.48	89.28	57.10	B
注：标准百分比=(所有评分者评估分数总和-最小可能分值)/(最大可能分值-最小可能分值)×100%。

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表 3 成人EN患者NGT喂养最佳证据总结

Table 3. Summary of best evidence for nasogastric tube feeding in adult enteral nutrition patients

项目	推荐意见	证据等级	推荐级别
组织与管理	1.组建多学科团队，包括营养师、护士、医师、药剂师，共同参与NGT喂养临床决策^{[15-16, 20-21]}。	1	A
	2.住院期间NGT置管及喂养需由经过教育和培训的专业人员进行^{[15, 20]}。	5	B
评估与筛查	3.推荐采用营养风险筛查量表(NRS-2002)或重症患者营养状况评估量表(NUTRIC评分)对EN患者进行营养风险筛查，记录结果并对高风险患者定期复评^[17-20]。	1	A
	4.NGT喂养前需评估共病情况(如吞咽、胃肠道、认知功能等)，选择合适评估工具评估误吸风险及喂养耐受性^{[17-18, 7, 27]}。	5	B
	5.建议常规评估NGT固定及管道刺激情况^{[15, 21, 28]}。	1	A
喂养启动前	6.NGT选择：成人常用型号为16Fr, 警觉患者置管时可采用利多卡因喷雾缓解不适^{[16, 28]}。	1	B
	7.NGT置管预测及位置确认。
	7.1推荐采用NEX+10 cm^[29]或GWNUF法^[30]对置管深度进行预测^{[16, 20, 21, 28]}。	1	A
	7.2 X线是NGT位置确认金标准^{[16, 18, 28]}。	1	A
	7.3标记外露长度、肉眼观察胃内容物及测定抽吸胃液pH值(pH＜5.5)可作为临床一线位置确认方法^{[15-16, 20-21, 23, 27]}。	2	A
	8. 建议采用基于体积的喂养方案，IC为热量确定金标准，IC不可取时，可使用基于重量的方程来确定能量需求，成人患者25~35 kcal/(kg·d)，重症患者前7~10 d内12~25 kcal/kg^[15-18]。	1	A
喂养执行流程	9.确定喂养方案。
	9.1推荐执行EN标准化电子医嘱，制定以护士驱动为主的NGT喂养方案，包括患者信息、给药率(实际喂养量/目标喂养量)、制剂选择、喂养方式、速率、冲洗方案、喂养期间并发症管理及结果，并定期(每周1~3次)评估记录方案可行性^{[16, 18, 20]}。	5	B
	9.2确定冲管液、体积、频率和时间。给药前后、连续喂养期间、间断喂养前后、GRV测量前后用温水10~30 mL脉冲冲管，免疫功能低下或危重患者采用无菌水冲洗^{[16, 18, 19-21]}。	2	A
	10.选择喂养方式。
	10.1长期喂养(大于2~3周)、老年卧床、危重症、术后早期、血糖波动大、输注大剂量、高渗透压、高粘稠度营养液及喂养不耐受者推荐采取持续喂养^{[16, 18, 21]}。	2	A
	10.2病情稳定或耐受持续喂养者，优先考虑间歇分次推注喂养^{[15-16, 27]}。	5	B
	11.喂养实施。
	11.1喂养前核对营养制剂及容器外标签，包括姓名、病历号、制剂类型、体积、喂养方式、开启时间等，开启后营养制剂应在2~6 ℃冰箱储存，有效期为24 h^{[16, 20, 22]}。	5	B
	11.2喂养时，床头抬高30°~45°，喂养结束后保持半卧位30~60 min^{[16, 20-22]}。	2	A
	12.喂养量及喂养速度、温度。
	12.1营养泵入时，初始速度为20~50 mL/h, 次日8~12 h增加10~20 mL/h至80~100 mL/h, 温度为38~40 ℃^{[17, 21]}。	2	A
	12.2分次喂养时，单次喂养量不超过400 mL，可采用50 mL以上灌食器4~10 min缓慢推注^[21]。	5	B
	13.注意事项。
	13.1建议每天使用氯己定漱口水进行口腔护理2次或遵医嘱使用促胃动剂^{[16-17, 21]}。	1	A
	13.2喂养遵循无菌原则，包括EN制剂配置、操作台面、喂养设备如注射器和容器等均要保持清洁^{[16, 20-21]}。	5	B
	13.3药物不与营养制剂混合，建议加水溶解后喂养^{[16, 20-21]}。	5	A
	13.4堵管时采用注射器抽取温水反复冲洗，必要时可使用碳酸氢钠或胰酶溶液^{[18, 21]}。	2	A
喂养监测	14.不常规监测GRV，GRV＞500 mL, 2 h后复测；GRV＞500 mL/6 h，延迟EN；若GRV＜500 mL且无其他喂养不耐受，继续EN喂养^[16]。	2	A
	15.持续喂养者，每4 h监测1次NGT位置；分次喂养时，每次喂养前监测^{[21, 28]}。	3	A
	16.连续评估喂养耐受性及误吸风险，并积极采取相应措施降低误吸风险、改善喂养不耐受症状^{[15-17, 20-22, 27]}。	2	A
中医护理	17.建议根据个体情况采用中医药方法如中药内服、外敷、中医非药物疗法等提高喂养耐受性，增强EN疗效^{[22, 26]}。	1	B
喂养设备管理	18.专人监控并维护营养泵，以降低因仪器所造成的不良事件及并发症发生率^[20-21]。	5	B
	19.喂养设备如开放性喂养管路、灌食器可循环使用时间不超过24 h^{[16, 24]}。	1	A
喂养终止时机	20.建议患者有足够口服量时考虑终止喂养，高误吸风险、GRV持续升高、持续FI考虑中断喂养^[15-16]。	2	A
健康教育	21.对患者及照顾者进行系统NGT喂养护理健康教育，包括喂养方案、冲洗方案、喂养设备管理、常见并发症处理，并采用面对面教育、小册子教育等方式协助完成出院后的家庭NGT喂养^{[16, 21]}。	5	B
注：NRS-2002为营养风险筛查2002(nutritional risk screening 2002)；NUTRIC为重症患者营养风险评分(nutrition risk in the intensive care patient)；NEX为鼻子到耳垂到胸骨剑突距离(nose-earlobe-xiphoid)；IC为间接测量法(indirect calorimetry)；GRV为胃残余量(gastric residual volume)；GWNUF模型公式为：29.38+4.53×性别+0.34×NUF-0.06×体质量，性别取值男性为1，女性为0，NUF为成人平躺时鼻尖至肚脐的距离。

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