上消化道术后患者肠内营养喂养不耐受预防及管理的循证护理实践  

Evidence-based nursing practice for prevention and management of enteral nutrition feeding intolerance in patients after upper gastrointestinal surgery

作　　者：康莉 王翠玲[2] 田佳 温雅 田建英[4] Kang Li;Wang Cuiling;Tian Jia;Wen Ya;Tian Jianying(School of Nursing,Shanxi Medical University,Taiyuan 030001,China;Nursing Department,Shanxi Provincial Cancer Hospital,Taiyuan 030013,China;Department of Radiation Oncology,Shanxi Provincial Cancer Hospital,Taiyuan 030013,China;Department of General Surgery,Shanxi Provincial Cancer Hospital,Taiyuan 030013,China)

机构地区：[1]山西医科大学护理学院,太原030001 [2]山西省肿瘤医院护理部,太原030013 [3]山西省肿瘤医院放疗科,太原030013 [4]山西省肿瘤医院普外科,太原030013

出　　处：《中华现代护理杂志》2021年第35期4811-4817,共7页Chinese Journal of Modern Nursing

摘　　要：目的将预防及管理上消化道术后患者肠内营养喂养不耐受的最佳证据应用于临床实践并评价其效果。方法以澳大利亚Joanna Briggs Institute(JBI)循证卫生保健中心临床证据实践应用模式为指导,根据专家意见筛选适合的最佳证据,并制订循证实践方案。采用便利抽样法,于2020年9—12月选取太原市某三甲医院普外科收治的84例患者以及21名护士为研究对象,对2020年9—10月收治的42例患者和21名护士进行基线审查,通过教育培训及质量监督促进实践变革,对2020年11—12月收治的42例患者和21名护士(与之前相同)进行再审查。比较证据应用前后患者喂养不耐受发生率及肠道功能恢复时间、护士对喂养不耐受预防及管理的知信行水平以及审查指标的执行率。结果证据应用后患者的腹胀、腹泻、喂养不耐受发生率低于证据应用前患者,差异有统计学意义(P<0.05)。证据应用后患者的术后首次肛门排气时间、首次肛门排便时间分别为(59.02±17.19)、(68.10±19.98)h,短于证据应用前患者的(78.79±22.34)、(82.76±22.35)h,差异均有统计学意义(P<0.01)。证据应用后护士的喂养不耐受预防及管理知信行问卷各维度得分高于证据应用前,差异有统计学意义(P<0.05)。证据应用前后,11条审查指标的执行率从0~78.57%提高到80.95%~100.00%。结论基于最佳证据的上消化道术后患者肠内营养喂养不耐受预防及管理策略应用于临床实践后,可规范护士实施肠内营养的工作行为,并降低患者喂养不耐受的发生率。Objective To apply the best evidence for prevention and management of enteral nutrition feeding intolerance in patients after upper gastrointestinal surgery to clinical practice and to evaluate its clinical effects.Methods Guided by the clinical evidence practice application model of the Joanna Briggs Institute(JBI)Evidence-based Healthcare Centre in Australia,the best appropriate evidence was selected based on expert advice and evidence-based practice protocols were developed.The convenient sampling method was adopted to select 84 patients and 21 nurses who were admitted to the Department of General Surgery in a ClassⅢGrade A hospital in Taiyuan from September to December 2020 as the research objects.A baseline review of 42 patients and 21 nurses admitted from September to October 2020 was conducted,and education,training and quality supervision were conducted to promote practice change.A total of 42 patients and 21 nurses(same as before)admitted from November and December 2020 were reviewed.Incidence of enteral feeding intolerance,the time to recovery of intestinal function,the knowledge,attitude and practice of nurses towards prevention and management of enteral feeding intolerance and implementation of audit indicators among nurses were compared before and after the application of the program.Results The incidence of abdominal distension,diarrhea and feeding intolerance in patients after the application of the evidence was lower than that in patients before the application of the evidence,and the difference was statistically significant(P<0.05).The first anal exhaust time and first anal defecation time of patients after the application of the evidence were(59.02±17.19)and(68.10±19.98)h,which were shorter than those before the application of evidence(78.79±22.34)and(82.76±22.35)h,and the differences were statistically significant(P<0.01).After the application of the evidence,the scores of all dimensions of nurses'knowledge,belief and practice questionnaire for the prevention and management of feeding int

关 键 词：营养支持 上消化道手术 肠内营养 喂养不耐受 循证护理 

分 类 号：R473.6[医药卫生—护理学]