重症病人腸胃道管灌常見合併症之預防

Preventing Common Enteral Feeding Complications in Critically Ill Adult Patients

營養支持是提供重症病人在面對疾病壓力與氧合所需能量的一種輔助性治療，可經由腸胃道管灌或非腸胃道方式提供給無法主動維持適當營養攝取的重症病人。腸胃道管灌比靜脈營養更能維持腸道完整性、有較低的感染併發症風險及營養治療費用，而早期的腸道營養支持，更被認為是一種可以減輕疾病嚴重度、減少合併症、縮短加護病房住院天數以及改善病人治療成效的積極治療策略，故重症病人之營養支持以腸胃道管灌為優先考量。然而，就像其他的治療一樣，腸胃道管灌也有其相關的危險性。護理人員應具備相關知識，以提供接受腸胃道管灌之重症病人適當的照護，因此，本文就腸胃道管灌臨床適應症、照護注意事項、常見合併症之評估與預防作深入介紹。其中照護注意事項包括：開始灌食的時機、確認灌食管路插入的位置、胃殘餘量的監測以及管路阻塞的預防與處置，而常見合併症主要介紹肺吸入、腹瀉、嘔吐、低血鈉與高血糖的評估與預防，上述實證知識可作為重症照護單位制訂灌食管路照護標準與規範及人員訓練之參考，並藉以提供病人適當的營養支持，進而促進病人的預後。

Nutritional support provides critically ill patients with energy and nutrients required to face the demands of their illness and stress. For those unable to ingest orally, enteral feeding rather than parenteral feeding is recommended, as the former better preserves gut integrity, reduces risk of infection, and costs less. Early enteral feeding in critically ill patients is also associated with decreased disease severity, reduced complications, and shortened length of stay. Risks associated with enteral feeding include aspiration, diarrhea, vomiting, hyponatremia, and hyperglycemia. This article reviews current knowledge on enteral feeding and addresses correct feeding tube placement, proper feeding sites, assessing and managing gastric residual volume, and preventing feeding tube occultation. We also review information related to identifying and controlling risk factors for enteral feeding complications such as aspiration, diarrhea, vomiting, hyponatremia, and hyperglycemia. Nurses can use this information to provide high quality care for enteral feeding patients and develop institutional protocols, guidelines, and standards of care for such patients in intensive care units.