胃手术后肠内营养相关性腹泻患者的循证护理  

Evidence-based Nursing for Patients with Enteral Nutrition Related Diarrhea after Gastric Operation

作　　者：黄明君[1] 李卡[1] 蒋理立[1] 

机构地区：[1]四川大学华西医院胃肠外科中心,四川成都610041

出　　处：《护理学报》2013年第13期48-50,共3页Journal of Nursing（China）

基　　金：四川省科技厅支撑项目(2012SZ0039)

摘　　要：目的运用循证方法,为胃手术后患者肠内营养相关腹泻制定合理的预防和治疗方案。方法根据患者病情,提出临床问题:营养液最佳输注设备;营养液的输注方式和温度;是否需要在营养液中添加治疗性物质或更换营养液。计算机检索Cochrane图书馆、Cochrane Central Register of Controlled Trials(CCRT)、Database of Abstracts of Reviews of Effects(DARE)、MEDLINE及中国生物医学文献数据库,查找筛选高质量临床文献证据,制定合理护理方案。结果共检索出针对肠内营养相关的腹泻问题方案相关的2篇系统评价、1篇Meta分析证据水平Ia级,证据分级A级;3篇随机对照研究证据水平Ib级,证据分级A级,2篇随机对照研究证据水平为IIb级,证据分级B级。将提取的证据应用于292例胃手术后患者,19例发生肠内营养相关腹泻(6.5%),低于同期研究的腹泻发生率;2例改为肠外营养,其他在进行有效护理后继续行肠内营养至恢复。结论肠内营养患者均使用营养泵进行输注,从小剂量、低浓度、低速度开始,逐步增加剂量,同时营养液需要加温;营养液可添加益生菌、膳食纤维免疫物质、抗氧化剂或使用含有这些物质的营养液,可以有效预防患者腹泻发生。Objective To explore how to prevent and treat enteral nutrition related diarrhea after gastric operation with evidence- based approach. Methods Clinical problems such as best enteral nutrition injection device, injection and temperature of solution, whether with an addition of therapeutic elements in enteral nutrition or not and change of nutrition solution were identified. A retrieval was conducted in Cochrane library, Cochrane Central Register of Controlled Trials （CCRT）, Database of Abstracts of Reviews of Effects （DARE）, MEDLINE and Chinese Biomedical Database for quality clinical literature then nursing methods were established based on the literature. Results Eight articles were obtained and evidences in these articles were applied in the treatment of 292 patients after gastric operation. Enteral nutrition related diarrhea occurred in 19 patients （6.5%） and the incidence was lower than that in the research in the same period. Parenteral nutrition was provided for two patients while enteral nutrition was maintained among other patients. Conclusion Nutrient solution could be injected with small dose, low concentration and low speed by feeding pump and heated solution with therapeutic elements is effective for the prevention of diarrhea.

关 键 词：胃手术 肠内营养 腹泻 循证护理 

分 类 号：R472.91[医药卫生—护理学]