ISSN 2097-6054(网络) ISSN 1672-9234(印刷) CN 11-5289/R
主管:中国科学技术协会 主办:中华护理学会
出版:中华护理杂志社
收录:中国科学引文数据库(CSCD)来源期刊
   中国期刊全文数据库
   中国核心期刊(遴选)数据库
   Scopus
临床实践

住院脑卒中患者营养管理的最佳证据总结

  • 马珂珂 ,
  • 郭园丽 ,
  • 董小方 ,
  • 杨彩侠 ,
  • 王爱霞
展开
  • 450000郑州市郑州大学第一附属医院
马珂珂:女,硕士,护师, E-mail : <email>809643627@qq.com</email>

网络出版日期: 2021-05-24

基金资助

河南省医学科技攻关计划省部共建项目(SBGJ202002061)

A summary of best evidence on management of nutrition in stroke patients

  • Ke-ke MA ,
  • Yuan-li GUO ,
  • Xiao-fang DONG ,
  • Cai-xia YANG ,
  • Ai-xia WANG
Expand

Online published: 2021-05-24

摘要

目的 总结、评价国内外关于住院脑卒中患者营养管理的最佳证据,为临床护理人员提供循证依据。 方法 检索UpToDate、BMJ best practice、Cochrane图书馆、苏格兰学院间指南网、中国生物医学文献数据库、万方数据库等国内外数据库,检索时间限制为建库至2020年5月1日,由2名研究者使用AGREEⅡ评价指南质量,使用JBI循证卫生保健中心对应的评价标准(2016)对系统评价和专家共识进行质量评价,并进行证据提取及汇总分析。 结果 纳入16篇文献,包括12篇指南、3篇系统评价和1篇专家共识,形成最佳证据33条,主要内容包括住院脑卒中患者营养风险筛查及评估、营养支持时机及途径选择2部分内容。 结论 本研究总结了住院脑卒中患者营养管理的最佳证据,能够为临床护理工作人员对住院脑卒中患者营养管理提供科学的依据,由于本研究总结的证据来自多个国家,在应用前应进行充分的临床环境及其他相关因素的评估,以促进护理质量的提升。

本文引用格式

马珂珂 , 郭园丽 , 董小方 , 杨彩侠 , 王爱霞 . 住院脑卒中患者营养管理的最佳证据总结[J]. 中华护理教育, 2021 , 18(5) : 456 -463 . DOI: 10.3761/j.issn.1672-9234.2021.05.016

Abstract

Objective To summarize and evaluate the best evidence of management of nutrition in stroke patients. Methods We searched evidence in UpToDate,BMJ best practice,the Cochrane Library,Scottish Inter-collegiate Guidelines Network,China Biology Medicine disc,and Wanfang database from their inception to May 1,2020. The quality assessment was conducted by two researchers by using AGREE Ⅱ for guidelines,JBI evidence-based health care center evaluate standards for systematic review,and expert consensus. Results A total of 16 articles were included in this study,including 12 guidelines,3 systematic reviews and 1 expert consensus. Thirty-three pieces of the best evidence were extracted including the nutrition screening and assessment as well as the time and method of nutrition support. Conclusion This study summarized the best evidence of the nutrition support of stroke patients. As evidences are from different countries,we suggest to assess the clinical environment and other related factors before evidence application to promote nursing quality.

参考文献

[1] Zhou MG, Wang HD, Zeng XY, et al. Mortality,morbidity,and risk factors in China and its provinces,1990-2017:a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2019,394(10204):1145-1158.
[2] Wang WZ, Jiang B, Sun HX, et al. Prevalence,incidence,and mortality of stroke in China:results from a nationwide population-based survey of 480 687 adults[J]. Circulation, 2017,135(8):759-771.
[3] Gomes F, Emery PW, Weekes CE. Risk of malnutrition is an independent predictor of mortality,length of hospital stay,and hospitalization costs in stroke patients[J]. J Stroke Cerebrovasc Dis, 2016,25(4):799-806.
[4] Zhang J, Zhao XQ, Wang AX, et al. Emerging malnutrition during hospitalisation independently predicts poor 3-month outcomes after acute stroke:data from a Chinese cohort[J]. Asia Pac J Clin Nutr, 2015,24(3):379-386.
[5] 王璐思, 邰春玲, 陈冬, 等. 脑卒中住院患者营养风险和营养支持现状调查[J]. 中华现代护理杂志, 2019,25(26):3353-3355.
[5] Wang LS, Tai CL, Chen D, et al. Nutritional risk and nutrition-al support of stroke patients during hospitalization[J]. Chin J Mod Nurs, 2019,25(26):3353-3355.
[6] 中国卒中吞咽障碍与营养管理共识专家组, 中国卒中学会, 国家神经系统疾病临床医学研究中心, 等. 中国卒中吞咽障碍与营养管理手册[J]. 中国卒中杂志, 2019,14(11):1153-1169.
[7] 朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017,32(21):1991-1994.
[7] Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence based problems[J]. J Nurses Train, 2017,32(21):1991-1994.
[8] 周芬, 郝玉芳, 丛雪, 等. 临床指南研究与评估系统Ⅱ(AGREE Ⅱ)2017更新版[EB/OL]. [2020-05-10] https://www.agreetrust.org/wp-content/uploads/2018/05/AGREE_II_Domain-Score-interpretation-Chinesesimplified.pdf.
[8] Zhou F, Hao YF, Cong X, et al. The appraisal of guidelines for research & evaluation instrument Ⅱ(AGREE Ⅱ)2017[EB/OL]. [2020-05-10] https://www.agreetrust.org/wp-content/uploads/2018/05/AGREE_II_Domain-Score-interpretation-Chinesesimplified.pdf.
[9] 周芬, 郝玉芳, 丛雪, 等. 指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J]. 护理学报, 2018,25(18):56-58.
[9] Zhou F, Hao YF, Cong X, et al. The supplementary explanations and reflections on the scores of AGREE Ⅱ[J]. J Nurs(China), 2018,25(18):56-58.
[10] 曹秋君, 吴燕. 预防静脉血液标本溶血的最佳证据总结[J]. 中华护理杂志, 2018,53(8):1000-1004.
[10] Cao QJ, Wu Y. Best evidence summary for prevention of hemolysis in venous blood specimen[J]. Chin J Nurs, 2018,53(8):1000-1004.
[11] Boulanger JM, Lindsay MP, Gubitz G, et al. Canadian stroke best practice recommendations for acute stroke management:prehospital,emergency department,and acute inpatient stroke care,6th edition,update 2018[J]. Int J Stroke, 2018,13(9):949-984.
[12] Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke:2019 update to the 2018 guidelines for the early management of acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2019,50(12):e344-e418.
[13] Teasell R, Salbach NM, Foley N, et al. Canadian stroke best practice recommendations:rehabilitation,recovery,and community participation following stroke. part one:rehabilitation and recovery following stroke;6th edition update 2019[J]. Int J Stroke, 2020,15(7):763-788.
[14] National Institute For Health and Care Excellence(NICE) Stroke and transient ischaemic attack in over 16s:diagnosis and initial management[EB/OL]. (2019-05-01)[2020-05-27]. https://www.nice.org.uk/guidance/ng128.
[15] National Institute For Health and Care Excellence(NICE) Nutrition support for adults:oral nutrition support,enteral tube feeding and parenteral nutrition[EB/OL]. (2017-08-04)[2020-05-27]. https://www.nice.org.uk/search?q=Nutrition+support+for+adults%3A+oral+nutrition+support%2C+enteral+tube+feeding+and+parenteral+nutrition.
[16] Gomes F, Hookway C, Weekes CE. Royal College of Physicians Intercollegiate Stroke Working Party evidence-based guidelines for the nutritional support of patients who have had a stroke[J]. J Hum Nutr Diet, 2014,27(2):107-121.
[17] National Stroke Foundation(NSF) Clinical guidelines for stroke management 2017[EB/OL]. (2017-09-07)[2020-05-01]. http://guide.medlive.cn/guideline/14688.
[18] Scottish Intercollegiate Guidelines Network(SIGN) Management of patients with stroke:identification and management of dysphagia:a national clinical guideline[EB/OL]. (2010-06-01)[2020-04-25]. http://www.sign.ac.uk.
[19] Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2016,47(6):e98-e169.
[20] Royal College of Physicians. National clinical guideline for stroke[EB/OL]. (2016-10-03)[2020-05-01]. https://www.nice.org.uk/occreditation.
[21] Burgos R, Bretón I, Cereda E, et al. ESPEN guideline clinical nutrition in neurology[J]. Clin Nutr, 2018,37(1):354-396.
[22] Wirth R, Wirth R, Smoliner C, et al. Guideline clinical nutrition in patients with stroke[J]. Exp Transl Stroke Med, 2013,5(1):14.
[23] Geeganage C, Beavan J, Ellender S, et al. Interventions for dysphagia and nutritional support in acute and subacute stroke[J]. Cochrane Database Syst Rev, 2012,10:CD000323.
[24] Visvanathan A, Dennis M, Whiteley W. Parenteral fluid regimens for improving functional outcome in people with acute stroke[J]. Cochrane Database Syst Rev, 2015(9):CD011138.
[25] Chen N, Li Y, Fang J, et al. Risk factors for malnutrition in stroke patients:a meta-analysis[J]. Clin Nutr, 2019,38(1):127-135.
[26] 王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015,30(11):964-967.
[26] Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015,30(11):964-967.
[27] Cai ZM, Wu YZ, Chen HM, et al. Being at risk of malnutrition predicts poor outcomes at 3 months in acute ischemic stroke patients[J]. Eur J Clin Nutr, 2020,74(5):796-805.
[28] Espuela FL, Roncero-Martin R, Zamorano JDP, et al. Controlling Nutritional Status(CONUT) score as a predictor of all cause mortality at 3 months in stroke patients[J]. Biol Res Nurs, 2019,21(5):564-570.
[29] Cohen DL, Roffe C, Beavan J, et al. Post-stroke dysphagia:a review and design considerations for future trials[J]. Int J Stroke, 2016,11(4):399-411.
[30] Ha L, Hauge T, Iversen PO. Body composition in older acute stroke patients after treatment with individualized,nutritional supplementation while in hospital[J]. BMC Geriatr, 2010,10:75.
[31] Gomes CA, Andriolo RB, Bennett C, et al. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances[J]. Cochrane Database Syst Rev, 2015(5):CD008096.
[32] Dennis MS, Lewis SC, Warlow C. Effect of timing and method of enteral tube feeding for dysphagic stroke patients(FOOD):a multicentre randomised controlled trial[J]. Lancet, 2005,365(9461):764-772.
[33] Norton B, Homer-Ward M, Donnelly MT, et al. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke[J]. BMJ, 1996,312(7022):13-16.
[34] 姜跃龙, 刘洁, 史济华, 等. 老年患者中风后长期吞咽功能障碍选择经皮内镜下胃造瘘术的影响因素分析[J]. 中华老年医学杂志, 2016,35(8):883-885.
[34] Jiang YL, Liu J, Shi JH, et al. Influencing factors of the choice of percutaneous endoscopic gastrostomy in elderly patients with dysphagia post stroke[J]. Chin J Geriatr, 2016,35(8):883-885.
[35] 郝小蕊, 赵昌盛. 肠内和肠外营养支持对早期重症脑卒中患者血清ALT、SCr浓度变化及并发症的影响[J]. 山东大学学报(医学版), 2019,57(3):80-84.
[35] Hao XR, Zhao CS. Effects of enteral and parenteral nutrition support on serum ALT,SCr and complications in patients with early severe stroke[J]. J Shandong Univ Heal Sci, 2019,57(3):80-84.
[36] Sánchez-Moreno C, Jiménez-Escrig A, Martín A. Stroke:roles of B vitamins,homocysteine and antioxidants[J]. Nutr Res Rev, 2009,22(1):49-67.
[37] 中国卒中营养标准化管理专家委员会. 中国卒中营养标准化管理专家共识[J]. 中国卒中杂志, 2020,15(6):681-689.
[37] Chinese Stroke Nutrition Standardization Management Expert Committee. Expert consensus on standardized nutrition management of stroke in China[J]. Chin J Stroke, 2020,15(6):681-689.
文章导航

/