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題 名 | 重症病人腸道營養給法標準之建立 |
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作 者 | 邱艷芬; | 書刊名 | 慈濟醫學 |
卷 期 | 6:3 1994.09[民83.09] |
頁 次 | 頁185-202 |
分類號 | 411.3 |
關鍵詞 | 腸道營養; 胃殘餘量; 腹瀉; 重症病人; Enteral nutrition; Gastrointestinal intolerance problem; Critically ill patients; |
語 文 | 中文(Chinese) |
中文摘要 | 本研究即在探討重症病人自腸道攝取營養之能力,找出有意義且方便使 用之指標,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 自教學醫院加護病房100位個案研提供448觀察,分析歸納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 嚴重度與灌食液種類;影響腸音的決定因素為:疾病嚴重程度、灌食速度、與水腫; 影響腹張的決定因素為: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 研究依據分析結果,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.宜考慮小量清淡飲食,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,為使進胃腸對 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。(慈濟醫學1994;6:185-202) |
英文摘要 | The purpose of this study was to identify predictive indices for the gastrointestinal tolerance of critically illpatients in order to guide safe and efficient administering of enteral nutrition. One hundred adults admitted toICUs of two teaching hospitals during the year of 1992 were included in this study. A total of 448 observationswere yielded for data analysis. The result indicated that the determinants of gastric residual were: severity ofillness (as measured by APACHE II score) and types of feeding formula; the determinants of bowel soundwere: severity of illness, feeding speed, and the presence of edema; the determinants of abdominal distensionwere: 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 serumpotassium levels. The proposed intervention for prevention and mamagement of above Gl intolerant problemswere: in patients with APACHE II score higher than 20, use of clear diet and feeding at slow speed to avoidlarge amount of gastric residual; high feeding speed may be beneficial to ileus patient to improve bowelmovement and would not contribute to diarrhea; usage of medicine promoting bowel movement may be necessary for patients on NPO restriction for more than 3 days; for better management of diarrhea problem, adjustingfeeding regimen according to patient's nutritional status, serum potassium levels, and cocommitant medicineswould be essential. (Tzu-Chi Med J 1994; 6: 185-202) |
本系統中英文摘要資訊取自各篇刊載內容。