广西医学

目的构建以超声监测为导向的机械通气患者肠内营养护理方案。方法组建多学科研究团队，采用文献分析法与半结构化访谈法，初步构建机械通气患者肠内营养护理方案草案。基于方案草案编制德尔菲法专家函询问卷并开展两轮专家函询。分析每轮函询专家的积极程度、专家权威程度及专家协调程度，并对每轮函询各条目进行重要性、可行性评分。计算各条目重要性、可行性的均分和变异系数，确定以超声监测为导向的机械通气患者肠内营养护理方案定稿。结果所构建的以超声监测为导向的机械通气患者肠内营养护理方案涵盖3个一级条目、6个二级条目、19个三级条目和44个四级条目。第1轮和第2轮函询的专家积极系数分别为93.75%、100.00%，专家权威系数分别为0.920、0.933，第2轮专家函询各条目的重要性、可行性的肯德尔和谐系数高于第1轮（P<0.05），最终构建的以超声监测为导向的机械通气患者肠内营养护理方案各条目的变异系数为0~0.18。结论以超声监测为导向的机械通气患者肠内营养护理方案具有较好的科学性、可靠性，可为临床制订机械通气患者个体化肠内营养策略、实施精细化肠内营养护理提供参考。

Objective To establish the nursing regimen of enteral nutrition in patients with mechanical ventilation guided by ultrasonic monitoring. Methods A multidisciplinary research team was established, and the draft of enteral nutrition nursing regimen for patients with mechanical ventilation was initially established by literature analysis and semi⁃structured interview methods. Based on the draft regimen, the Delphi method expert letter consultation questionnaire was designed, and two rounds of expert letter consultation were carried out. The positive degree of experts for letter consultation in each round, expert authority degree and the coordination degree in each round were analyzed, and importance and feasibility to letter consultation for various items in each round were scored. The average scores and variable coefficient of importance and feasibility of various items were calculated to determine the final enteral nutrition nursing regimen for patients with mechanical ventilation guided by ultrasonic monitoring. Results The established enteral nutrition nursing regimen for patients with mechanical ventilation guided by ultrasonic monitoring covered 3 first⁃level items, 6 second⁃level items, 19 third⁃level items, and 44 fourth⁃level items. The positive coefficient of experts for letter consultation on the first and second rounds was 93.75% and 100.00%, respectively, and the experts authority coefficient was 0.920 and 0.933, respectively, as well as the Kendall coefficient of concordance of importance and feasibility in various items consulted by expert letter on the second round was higher than that on the first round (P<0.05). The variable coefficient of various items for enteral nutrition nursing regimen in patients with mechanical ventilation guided by ultrasonic monitoring finally established was 0-0.18. Conclusion Enteral nutrition nursing regimen in patients with mechanical ventilation guided by ultrasonic monitoring exerts favorable scientificity and reliability, which can provide references for formulating individualized enteral nutrition strategies, implementing refined enteral nutrition nursing in patients with mechanical ventilation in clinics.