摘要
总结1例一例脓毒症休克患者的营养护理经验。此次研究选取了一例脓毒症休克患者患者作为研究对象，通过对该病例资料进行全面的总结与分析，明确了护理实践的要点，进而制定出针对性的护理措施，显著改善患者病情状态。护理实践要点：根据脓毒症休克的疾病发展规律，基于脓毒症休克引发的胃肠道功能损伤生理改变，制定分级营养护理管理；首先完善患者营养风险筛查、体格检查、实验室检查；临床实践形成基于AGI分级肠道康复措施，在此基础上制定序贯营养治疗方案，实行低热卡过渡等热卡能量喂养的营养支持策略。经上述护理措施30天后，患者循环呼吸平稳，感染受控，体重无减轻，通过肠内营养满足热卡需要,家属因患者意识恢复缓慢同意转院治疗。
关键词： 急性胃肠损伤；脓毒症休克；营养支持
Abstract
Summarize the nutritional nursing experience of one patient with septic shock. This study selected a patient with septic shock as the research object. Through comprehensive summary and analysis of the case data, the key points of nursing practice were clarified, and targeted nursing measures were formulated to significantly improve the patient's condition. Key points of nursing practice: Based on the disease development law of septic shock and the physiological changes of gastrointestinal functional damage caused by septic shock, formulate graded nutritional nursing management; Firstly, improve patient nutritional risk screening, physical examination, and laboratory testing; Based on AGI grading intestinal rehabilitation measures in clinical practice, a sequential nutritional treatment plan is developed, and a nutritional support strategy of low calorie transition and other calorie energy feeding is implemented. After 30 days of the above nursing measures, the patient's circulation and breathing were stable, the infection was under control, and there was no weight loss. The patient's calorie needs were met through enteral nutrition. The family agreed to transfer the patient for treatment due to slow recovery of consciousne.
Key words： acute gastrointestinal injury; septic shock; Nutritional support
参考文献 References
[1] 李伦超1,单凯1,赵雅萍1,郭伟1,何新华2,郭树彬2.2018年欧洲肠外肠内营养学会重症营养治疗指南(摘译)[J].临床急诊杂志,2018,(第11期).
[2] The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020). Acute Med Surg. 2021 Aug 26;8(1):e659.
[3] 亚洲急危重症协会中国腹腔重症协作组. 重症病人胃肠功能障碍肠内营养专家共识（2021版)
[4] Wong A, et al. Curr Opin Crit Care. 2021, 27(2):147-156.
[5] 赵明曦，孙建华，李奇，等 . 床旁超声评估重症患者胃肠功能的最佳证据总结［J］. 中华现代护理杂志，2022，28（5）：602-610.
[6] 袁梦湄1,黄晓霞2,唐佳迎2,封秀琴1.以腹内压监测为导向的腹腔高压患者肠内营养护理方案的构建及应用[J].中华护理杂志,2023,(第12期).
[7] van Zanten ARH, De Waele E, Wischmeyer PE. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Crit Care. 2019 Nov 21;23(1):368.
[8] 中华医学会肠外肠内营养学分会.中国成人患者肠外肠内营养临床应用指南（2023 版）中华医学杂志, 2023, 103(13): 946-974.
[9] 中华医学会重症医学分会.中国成人ICU患者营养评估与监测临床实践指南[J].中华危重病急救医学,2023,(第11期).
[10] The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020). Acute Med Surg. 2021 Aug 26;8(1):e659.