AIM:To evaluate and summarize the evidence for prevention and management of enteral feeding intolerance in critically ill patients and provide reference for clinical practice. DESIGN:This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing. METHODS:Current literatures were systematically searched for the best evidence for prevention and management of enteral feeding intolerance in critically ill patients. Literature types included clinical guidelines, best practice information sheets, expert consensuses, systematic reviews, evidence summaries and cohort studies. DATA SOURCES:UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Scottish Intercollegiate Guidelines Network, the Cochrane Library, Embase, PubMed, Sinomed, Web of Science, Yi Maitong Guidelines Network, DynaMed, MEDLINE, CNKI, WanFang database, Chinese Medical Journal Full-text Database, European Society for Clinical Nutrition and Metabolism website, the American Society for Parenteral and Enteral Nutrition website were searched from January 2012 to April 2023. RESULTS:We finally identified 18 articles that had high-quality results. We summarized the 24 pieces of best evidence from these articles, covering five aspects: screening and assessment of the risk of enteral nutritional tolerance; formulation of enteral nutrition preparations; enteral nutritional feeding implementation; feeding intolerance symptom prevention and management; and multidisciplinary management. Of these pieces of evidence, 19 were 'strong' and 5 were 'weak', 7 pieces of evidence were recommended in level one and 4 pieces of evidence were recommended in level two. CONCLUSION:The following 24 pieces of evidence for prevention and management of enteral feeding intolerance in critically ill patients were finally recommended. However, as these evidences came from different countries, relevant factors such as the clinical environment should be evaluated before application. Future studies should focus on more specific symptoms of feeding intolerance and more targeted prevention design applications. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE:The clinical medical staffs are recommended to take evidence-based recommendations for the implementation of standardized enteral nutrition to improve patient outcomes and decrease gastrointestinal intolerance in critically ill patients. IMPACT:The management of enteral nutrition feeding intolerance has always been a challenge and difficulty in critically ill patients. This study summarizes 24 pieces of the best evidence for prevention and management of enteral nutrition feeding intolerance in critically ill patients. Following and implementing these 24 pieces of evidence is beneficial to the prevention and management of feeding intolerance in clinical practice. The 24 pieces of evidence include five aspects, including screening and assessment of the risk of enteral nutritional tolerance, formulation of enteral nutrition preparations, enteral nutritional feeding implementation, feeding intolerance symptom prevention and management and multidisciplinary management. These five aspects constitute a good implementation process. Screening and assessment of enteral nutritional tolerance throughout intervention are important guarantees for developing a feasible nutrition program in critically ill patients. This study will be benefit to global medical workers in the nutritional management of critically ill patients. REPORTING METHOD:This evidence summary followed the evidence summary reporting specifications of Fudan University Center for Evidence-based Nursing, which were based on the methodological process for the summary of the evidence produced by the Joanna Briggs Institute (JBI). The reporting specifications include problem establishment, literature retrieval, literature screening, literature evaluation, the summary and grading of evidence and the formation of practical suggestions. This study was based on the evidence summary reporting specifications of the Fudan University Center for the Evidence-based Nursing, the register name is 'Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients', the registration number is 'ES20231823'.

目的 探讨维持性血液透析(MHD)患者衰弱发生现状与影响因素,以便为构建护理干预措施提供依据.方法 于2021年12月—2022年3月,采用一般资料调查表、综合医院焦虑抑郁量表(HADS)、埃德蒙顿衰弱量表(EFS)对衡阳市某三级甲等医院血液净化中心的216例MHD患者进行调查,采用单因素分析、多因素Logistic回归分析,确定血透患者衰弱发生的影响因素.结果 MHD患者衰弱发生率为46.76％;多因素Logistic回归分析显示,年龄、服药种类、透析充分性、跌倒史为促成MHD患者衰弱发生的影响因素,白蛋白水平高、握力大为减少衰弱发生的因素,差异有统计学意义(P<0.05).结论 MHD患者衰弱发生率较高,且与年龄、白蛋白水平、服药种类、跌倒史、握力、透析充分性密切相关,针对上述影响因素尽早实施相应的护理干预措施,以降低MHD患者衰弱发生率.

目的:了解骨质疏松性椎体压缩性骨折患者骨质疏松知识和健康行为水平的现状,并分析两者之间的相关性.方法:采用便利抽样法选取2021年1-6月衡阳市某4家三级医院收治的300例骨质疏松性椎体压缩性骨折患者作为研究对象.采用骨质疏松知识问卷(OKT)及骨质疏松健康行为量表进行调查,并探讨两者之间的关系.结果:OKT总分平均(8.38±4.57)分;健康行为总分平均(52.93±7.52)分,两者总分均未达标;Pearson相关性分析显示,骨质疏松(OP)知识与健康行为总分呈正相关(r=0.678,P<0.01)

目的 分析老年股骨颈骨折患者术后生活质量的影响因素.方法 回顾性选取2021年1月至2022年12月九江市第一人民医院收治的155例股骨颈骨折患者作为研究对象,并对影响患者术后生活质量的因素进行分析.结果 两组年龄、家庭平均月收入、体重指数、Harris评分比较,差异有统计学意义(P＜0.05).多因素分析显示,年龄≥ 70 岁(β=-3.914,OR=2.278,95％CI:1.006～5.155),家庭平均月 收入 v2 500 元(β=0.823,OR=2.719,95％CI:1.143～6.464),BMI≥24 kg/m2(β=1.526,OR=4.598,95％CI:1.729～12.229),Harris 评分＜70 分(β=1.927,OR=6.866,95％CI:2.586～18.235),自我效能感低(β=1.653,OR=5.225,95％CI:2.152～12.682)是老年股骨颈骨折患者术后生活质量的危险因素.结论 老年股骨颈骨折患者术后生活质量受其年龄、家庭平均月收入、BMI、Harris评分、自我效能感影响,临床可以此进行针对性干预.

目的 通过Meta分析系统评价维持性血液透析(maintenance hemodialysis,MHD)患者跌倒的发生率及影响因素.方法 计算机检索Web of Science、the Cochrane Library、EMbase、PubMed、中国生物医学数据库(CBM)、中国知网(CNKI)、维普数据库和万方数据库关于维持性血液透析跌倒发生率及影响因素的研究.检索时间为建库至2021年4月,利用Stata 12.0和Revman 5.3软件对符合纳排标准的文献进行系统评价.结果 纳入6项横断面研究,5项队列研究和1项病例对照研究,共2656位患者.Meta分析结果显示,维持性血液透析患者跌倒的总体发生率及95％CI为25％(0.19,0.30).各危险因素的OR或SMD及95％CI为:高血压1.50(0.84,2.67)、透析中低血压2.12(1.65,2.72)、糖尿病2.49(1.96,3.16)、衰弱3.15(2.01,4.92)、抑郁4.07(2.29,7.23)、外周血管疾病7.49(1.57,35.67)、使用辅助器械3.34(2.10,5.33)、年龄0.39(0.16,0.61)、透析龄0.25(0.05,0.45)、保护因素为血红蛋白-0.43(-0.61,-0.26).结论 维持性血液透析患者跌倒的危险因素众多,应尽早进行MHD患者跌倒风险评估并行早期预防和干预.

目的 探讨2型糖尿病患者(T2DM)并发糖尿病肾病(DKD)微量白蛋白尿的影响因素.方法 选取2020年8月至2021年4月衡阳市某两所三甲医院收治的308例T2DM患者作为研究对象,根据患者是否出现微量白蛋白尿进行分组,即尿白蛋白排泄率(UAER)为30～300 mg/24 h纳入DKD组,UAER＜30 mg/24 h纳入非DKD组.采用二元logistic回归分析T2DM患者发生DKD的影响因素.结果 本研究的308例T2DM患者中,DKD微量白蛋白尿患者有136例(44.16％),非DKD微量白蛋白尿患者有172例(55.84％).单因素分析结果显示,DKD组的年龄、糖尿病病程、收缩压、舒张压、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、高血压史人数占比、腹型肥胖人数占比高于非DKD组,自我效能评分、健康促进生活方式评分低于非DKD组,差异有统计学意义(P＜0.05);二元logistic回归分析结果显示,糖尿病病程(β=0.055,OR=1.057,95％CI=1.007～1.109)、收缩压(β =0.039,OR=1.040,95％ CI=1.016～1.064)、LDL-C (β=0.333,OR=1.395,95％CI=1.017～1.914)、腹型肥胖(β=0.596,OR=1.815,95％ CI=1.039～3.171)、HbA1c (β=0.182,OR=1.199,95％CI=1.071～1.344)是T2DM患者发生DKD微量白蛋白尿的危险因素(P＜0.05),健康促进生活方式评分(β=-0.018,OR =0.983,95％CI=0.967～0.998)、自我效能评分(β=-0.029,OR=0.972,95％CI=0.948～0.996)是T2DM患者发生DKD微量白蛋白尿的保护因素(P＜0.05).结论 随着糖尿病病程延长、血糖控制不佳,T2DM患者极易并发肾脏疾病,护理人员需注重提高患者的自我效能,倡导健康促进生活方式,从而预防或延缓DKD微量白蛋白尿的发生.

目的:分析生态瞬时评估法在疲乏纵向研究中的研究现状、趋势和发展前沿,为生态瞬时评估法在我国的进一步发展与应用提供参考和方向.方法:Web of Science核心合集数据库为数据来源,运用CiteSpace软件从文献年度发文量、国家和机构、学科领域分布、高频关键词及文献共被引5个方面进行可视化分析.结果:纳入444篇文献,发文量呈逐年上升趋势;美国发文量居首位;高强度突现学科为"ONCOLOGY""NURSING""PUBLIC,ENVIRONMENTAL&OCCUPATIONAL HEALTH"等;高频关键词为疲乏、生活质量、抑郁、症状、疼痛等;形成10个聚类群,分别为研究的疾病、内容与方法3个方面;被引文献的被引频次与中心性均较低.结论:目前生态瞬时评估法在国外疲乏纵向研究的领域与范围较小,多集中在临床医学护理领域,未来研究的热点会是抑郁、疼痛、失眠以及症状群等与生活质量相关的内容,提示研究者今后不仅要注重研究方向与研究内容的深层次开展,更要关注新方向、新主题的研究.

目的 调查不同射血分数类型慢性心衰患者存在营养不良风险的情况,并分析相关影响因素.方法 以2020年8-12月收治于衡阳市某三级甲等医院心内科的慢性心衰患者作为调查对象,采用一般资料调查问卷、营养风险筛查量表(NRS-2002)进行调查及评估.结果 共调查患者329例,存在营养不良风险者155例,占47.11％.其中,射血分数降低组患者中存在营养不良风险者占57.71％,高于射血分数中间值组(37.50％)和射血分数保留组(32.93％).logistic回归分析显示,年龄≥70岁、N末端B型利钠肽前体(NT-proBNP)及射血分数<40％均是慢性心衰营养不良风险的影响因素(P<0.05),淋巴细胞数值是其保护性因素(P<0.05).结论 慢性心衰患者存在较高的营养不良风险,其中射血分数降低的患者营养不良风险更高.临床护理工作中,应对年龄≥70岁、射血分数<40％及NT-proBNP升高的慢性心衰患者实施有针对性的营养评估,以及时发现患者的营养问题并进行干预,促进患者预后改善和生活质量提升.