择期手术儿童术前禁食管理的最佳证据总结  

The best evidence for preoperative fasting management in children undergoing elective surgery

作　　者：向华娟 黄华平 甘皓月 伍苑晨 陈龙平 XIANG Huajuan;HUANG Huaping;GAN Haoyue;WU Yuanchen;CHEN Longping(Operating Room,Mianyang Hospital Affiliated to School of Medicine,University of Electronic Science and Technology,Mianyang Central Hospital,Mianyang 621000,Sichuan,China;Nursing Department,Mianyang Hospital Affiliated to School of Medicine,University of Electronic Science and Technology,Mianyang Central Hospital,Mianyang 621000,Sichuan,China;Anesthesiology Department,Mianyang Hospital Affiliated to School of Medicine,University of Electronic Science and Technology,Mianyang Central Hospital,Mianyang 621000,Sichuan,China)

机构地区：[1]电子科技大学医学院附属绵阳医院·绵阳市中心医院手术室,四川绵阳621000 [2]电子科技大学医学院附属绵阳医院·绵阳市中心医院护理部,四川绵阳621000 [3]电子科技大学医学院附属绵阳医院·绵阳市中心医院麻醉科,四川绵阳621000

出　　处：《中国现代手术学杂志》2024年第5期411-418,共8页Chinese Journal of Modern Operative Surgery

基　　金：四川省卫生健康委员会科研课题(20PJ260)。

摘　　要：目的检索并总结择期手术儿童术前禁食管理的最佳证据,为临床优化围手术期处理方法提供参考。方法系统检索关于择期手术儿童术前禁食管理的文献,主要数据库包括Up to Data、BMJ Best Practice、JBI数据库、美国国家指南库(National Guideline Clearinghouse,NGC)、英国国家卫生与临床优化研究所(National Institute of Clinical Evidence,NICE)、苏格兰校际指南网络(Scottish Intercollegiate Guidelines Network,SIGN)、EBSCO、EMbase、Cochrane Library、PubMed、Web of Science、临床循证医学检索系统(Evidence-Based Medicine,EBM)、中国生物医学文献数据库(Chinese Biomedical Literature Database,CBM)、中国知网、万方数据库等。检索时间为数据库建立到2023年10月。采用2012年更新的英国《临床指南研究与评价系统Ⅱ》对文献进行评价,采用澳大利亚乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健中心的文献评价标准和证据分级系统对检索文献进行质量评价,对证据进行分级评价。结果共计纳入8篇文献,其中指南3篇,专家共识1篇,系统综述1篇,随机对照实验1篇,队列研究1篇,病例对照研究1篇。总结了18条择期手术儿童术前禁食时间管理的证据,包括儿童术前禁食风险评估,儿童术前禁食方案的制定依据,患儿禁食方案的制定以及异常情况检测。结论医务人员应选择性地采用相关级别的循证证据,为儿童围术期饮食管理实施科学化方案,缩短围术期的禁饮禁食时间,提升患儿舒适度,提高父母满意度。同时,应当充分考虑个性化差异,在应用过程中应注意对证据进行筛选后再使用,根据儿童患者个体情况制定有针对性的围术期饮食管理方案。Objective To search and summarize the best evidence for preoperative fasting management in children undergoing elective surgery,and to provide reference for clinical practice.Methods Databases such as Up to Data,BMJ Best Practice,JBI Database,National Guideline Clearinghouse(NGC)of USA,National Institute of Clinical Excellence(NICE)of UK,Scottish Intercollegiate Guidelines Network(SGN),EBSCO,EMbase,Cochrane Library,PubMed,Web of Science,and Evidence-Basecl Medicine(EBM),Chinese Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI),and Wanfang Database were searched until October 2023.The guidelines were evaluated using the 2012 Clinical Guidelines Research and Evaluation SystemⅡ.And the quality and evidence grading evaluation of different studies were conducted using the Australian JBI Evidence Based Health Care Center's literature evaluation standards and evidence grading system.Results A total of 8 articles were included,including 3 guidelines,1 expert consensus,1 systematic review,1 randomized controlled experiment,1 cohort study,and 1 case control study.18 pieces of evidence was summarized on the management of preoperative fasting time for children undergoing elective surgery,including risk assessment of preoperative fasting for children,basis for developing preoperative plans for children,formulation of fasting plans for pediatric patients,detection of abnormal conditions,and detection of abnormal conditions.Conclusions Medical personnel should implement scientific practices for perioperative dietary management of children based on relevant levels of evidence-based medical evidence,shorten the period of fasting and no drinking,improve the comfort of children,and increase parental satisfaction.At the same time,evidence should be screened and applied according to individual conditions during the application process,and personalized perioperative dietary management plans should be developed based on the specific situation of patients.

关 键 词：择期手术 儿童 禁食禁饮 证据总结 

分 类 号：R47[医药卫生—护理学]