以质量求发展，以服务铸品牌

护理学报 ›› 2020, Vol. 27 ›› Issue (24): 24-30.doi: 10.16460/j.issn1008-9969.2020.24.024

• 循证护理 • 上一篇    下一篇

轻、中重症急性胰腺炎患者早期经口进食的循证实践

曹春菊1a, 张兰芳2, 王彩芳1b, 罗丹华1b, 徐秀平1a, 庄聪琼1a, 黄梅英1a, 黄炜铃1a, 李文英1a   

  1. 1.广州医科大学附属第六医院（清远市人民医院）a.普外科;b.护理部,广东 清远511518;
    2.南方医科大学南方医院,广东 广州510400
  • 收稿日期:2019-12-03 出版日期:2020-12-25 发布日期:2021-01-15
  • 作者简介:曹春菊（1981-）,女,湖南永州人,硕士,副主任护师,副教授,护士长。

Best Evidence Summary for Early Oral Feeding in Patients with Mild to Moderate Severe Acute Pancreatitis

CAO Chun-ju1a, ZHANG Lan-fang2, WANG Cai-fang1b, LUO Dan-hua1b, XU Xiu-ping1a, ZHUANG Cong-qiong1a, HUANG Mei-ying1a, HUANG Wei-ling1a, LI Wen-ying1a   

  1. 1a. Dept. of General Surgery; 1b. Dept. of Nursing Administration, Qingyuan People’s Hospital, the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan 511518, China;
    2. Nanfang Hospital, Southern Medical University, Guangzhou 510400, China
  • Received:2019-12-03 Online:2020-12-25 Published:2021-01-15

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摘要： 目的 总结急性胰腺炎患者早期经口进食的最佳证据,并评价其应用效果。方法 通过对急性胰腺炎早期经口进食相关主题的系统检索及质量评价,纳入指南10篇,专家共识4篇,系统评价和综述11篇,随机对照研究3篇,总结9条最佳证据。并结合临床情景和专业判断,制订了5条基于证据的质量审查标准,在普外科病房开展质量审查。结果 证据应用前后,医护人员对最佳证据的知晓率提高,患者恶心、呕吐、腹痛、腹胀并发症发生率,血清淀粉酶、脂肪酶变化差异无统计学意义（P>0.05）,患者进食时间提早,患者住院时间缩短（P<0.001）。结论 基于证据的轻、中重症急性胰腺炎患者早期进食的最佳证据应用,能有效提高医护人员应用证据的依从性,促进患者康复。

关键词: 急性胰腺炎, 早期进食, 经口进食, 循证实践

Abstract: Objective To summarize the best evidence of early oral feeding in patients with acute pancreatitis and evaluate its effect. Methods Through systematic retrieval and quality evaluation of the literature regarding early oral feeding of patients with acute pancreatitis, 10 guidelines, 4 expert consensus,11 articles of systematic evaluation and review, and 3 articles of RCT were included and 9 pieces of best evidence were summarized. Combined with clinical situation and professional judgment, 5 evidence-based quality review standards were formulated and quality review was carried out in general surgical wards. Results Before and after the application of the evidence, the awareness rate of the best evidence was improved. The incidence of nausea, vomiting, abdominal pain and abdominal distension complications and the changes of serum amylase and lipase were not statistically significant (P>0.05) but the time of eating was earlier, and the length of hospital stay was shorter (P<0.001). Conclusion The best evidence application of early oral feeding in patients with acute pancreatitis based on evidence can effectively improve the compliance of medical staff to use evidence and promote the recovery of patients.

Key words: acute pancreatitis, early feeding, eating orally, evidence-based practice

中图分类号: 

  • R473.57
[1] Vege SS, Gardner TB,Chari ST,et al.Low Mortality and High Morbidity in Severe Acute Pancreatitis without Organ Failure:A Case for Revising the Atlanta Classification to Include “Moderately Severe Acute Pancreatitis”[J].Am J Gastroenterol,2009,104(3):710-715.DOI:10.1038/ajg.2008.77.
[2] Ragins H, Levenson SM, Signer R, et al.Intrajejunal Administration of an Elemental Diet at Neutral PH Avoids Pncreatic Stimulation[J]. Am J Surg, 1973,126(5):606-614.DOI:10.1016/s0002-9610(73)80007-8.
[3] Petrov MS, McIlroy K, Grayson L, et al. Early Nasogastric Tube Feeding Versus Nil Per Os in Mild to Moderate Acute Pancreatitis: A Randomized Controlled Trial[J]. Clin Nutr, 2013,32(5):697-703. DOI:10.1016/j.clnu.2012.12.011.
[4] Jacobson BC, Vander Vliet MB,Hughes MD,et al.A Prospective,Randomized Trial of Clear Liquids Versus Low-fat Solid Diet as the Initial Meal in Mild Acute Pancreatitis[J]. Clin Gastroenterol Hepatol,2007,5(8):946-951.DOI:10.1016/j.cgh.2007.04.012.
[5] Sathiaraj E, Murthy S, Mansard MJ, et al.Clinical Trial: Aral Feeding with a Soft Diet Compared with Clear Liquid Ciet as Initial Meal in Mild Acute Pancreatitis[J]. Aliment Pharmacol Ther,2008,28(6):777-781. DOI:10.1111/j.1365-2036.2008.03794.x
[6] Oláh A, Romics L Jr.Evidence-based Use of Enteral Nutrition in Acute Pancreatitis[J]. Langenbecks Arch Surg,2010,395(4):309-316. DOI:10.1007/s00423-010-0631-4.
[7] Petrov MS, Van Santvoort HC, Besselink MG, et al.Enteral Nutrition and the Risk of Mortality and Infectious Complications in Patients with Severe Acute Pancreatitis: A Meta-analysis of Randomized Trials[J]. Arch Surg,2008,143(11):1111.DOI:10.1001/archsurg.143.11.1111.
[8] Wang G, Wen J, Xu L, et al.Effect of Enteral Nutrition and Ecoimmunonutrition on Bacterial Translocation and Cytokine Production in Patients with Severe Acute Pancreatitis[J]. J Surg Res,2013,183(2):592-597. DOI:10.1016/j.jss.2012.12.010.
[9] Casas M, Mora J, Fort E, et al.Total Enteral Nutrition vs. Total Parenteral Nutrition in Patients with Severe Acute Pancreatitis[J].Rev Esp Enferm Dig, 2007,99(5):264-269. DOI:10.4321/s1130-01082007000500004.
[10] Gupta R, Patel K, Calder PC, et al.A Randomised Clinical Trial to Assess the Effect of Total Enteral and Total Parenteral Nutritional Support on Metabolic, Inflammatory and Oxidative Markers in Patients with Predicted Severe Acute Pancreatitis(APACHE II >or=6)[J].Pancreatology,2003,3(5):406-413. DOI:10.1159/000073657.
[11] Yi F, Ge L, Zhao J, et al.Meta-analysis: Total Parenteral Nutrition Versus Total Enteral Nutrition in Predicted Severe Acute Pancreatitis[J]. Intern Med, 2012,51(6):523-530. DOI:10.2169/Internalmedicine.51.6685.
[12] Aromataris E, Fernandez R, Godfrey C M, et al.Summarizing Systematic Reviews: Methodological Development,Conduct and Reporting of an Umbrella Review Approach[J]. Int J Evid Based Healthc,2015, 13(3):132140.DOI:10.1097/XEB.0000000000000055.
[13] Dicenso A, Bayley L, Haynes RB.Accessing Pre-appraised Evidence: Fine-tuning the 5S Model into a 6S Model[J].Evid Based Nurs,2009,12(4):99-101. DOI:10.1136/ebn.12.4.99-b.
[14] 中华医学会消化病学分会胰腺疾病学组,《中华胰腺病杂志》编辑委员会,《中华消化杂志》编辑委员会.中国急性胰腺炎诊治指南(2013年,上海)[J].临床肝胆病杂志,2013,29(9):656-660.
[15] 吴超君,缪晶,张昕童,等.成人输液港堵塞预防与处理的证据总结[J].中华护理杂志,2018,53(3):346-351.
[16] 中国医师协会急诊医师分会.2013中国急诊急性胰腺炎临床实践指南[J].中国急救医学,2013,33(12):1057-1071. DOI:10.3969/j.issn.1002-1949.2013.12.001.
[17] 中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].临床肝胆病杂志,2015,31(1):17-20.
[18] Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology. American College of Gastroenterology Guideline: Management of Acute Pancreatitis[J]. Am J Gastroenterol,2013,108(9):1400-1416.DOI:10.1038/ajg.2013.218.
[19] Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA Evidence-based Guidelines for the Management of Acute Pancreatitis[J].Pancreatology,2013,13(4 Suppl 2):e1-e15. DOI:10.1016/j.pan.2013.07.063.
[20] Italian Association for the Study of the Pancreas (AISP), Pezzilli R, Zerbi A, et al. Consensus Guidelines on Severe Acute Pancreatitis[J]. Dig Liver Dis,2015,47(7):532-543. DOI:10.1016/j.dld.2015.03.022.
[21] Yokoe M, Takada T, Mayumi T, et al.Japanese Guidelines for the Management of Acute Pancreatitis: Japanese Guidelines 2015[J]. J Hepatobiliary Pancreat Sci, 2015,22(6):405-432. DOI:10.1002/jhbp.259.
[22] Greenberg JA, Hsu J, Bawazeer M, et al.Clinical Practice Guideline: Management of Acute Pancreatitis[J]. Can J Surg,2016,59(2):128-140. DOI:10.1503/cjs.015015.
[23] Crockett SD, Wani S, Gardner TB, et al.American Gastroenterological Association Institute Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis[J].Gastroenterology,2018,154(4):1096-1101. DOI:10.1053/j.gastro.2018.01.032.
[24] Samarasekera E, Mahammed S, Carlisle S, et al.Guideline Committee. Pancreatitis: Summary of NICE Guidance[J].BMJ,2018(362):k3443.DOI:10.1136/bmj.k3443.
[25] 中国医师协会胰腺病学专业委员会.中国急性胰腺炎多学科诊治共识意见[J].临床肝胆病杂志, 2015, 31(11):1770-1775. DOI:10.3969/j.issn.1001-5256.2015.11.003.
[26] 浙江省医学会重症医学分会.浙江省重症急性胰腺炎诊治专家共识[J].浙江医学,2017,39(14):1131-1150,1161.
[27] 中国中西医结合学会消化系统疾病专业委员会.急性胰腺炎中西医结合诊疗共识意见(2017年)[J].中国中西医结合消化杂志,2017, 25(12):901-909.DOI:10.3969/j.issn.1671-038X.2017.12.03.
[28] 中华中医药学会脾胃病分会,张声生,李慧臻.急性胰腺炎中医诊疗专家共识意见(2017)[J].中华中医药杂志,2017,32(9):4085-4088.
[29] Horibe M, Nishizawa T, Suzuki H, et al.Timing of Oral Refeeding in Acute Pancreatitis: A Systematic Review and Meta-analysis. United European Gastroenterol[J]. 2016,4(6):725-732. DOI:10.1177/2050640615612368.
[30] Vaughn VM, Shuster D, Rogers MAM, et al.Early Versus Delayed Feeding in Patients with Acute Pancreatitis: A Systematic Review[J].Ann Intern Med, 2017,166(12):883-892. DOI:10.7326/M16-2533.
[31] 赵茂晶,张咏梅,任娜娜,等.早期经口进食对轻症急性胰腺炎患者预后影响的Meta分析[J].胃肠病学和肝病学杂志,2017,26(5):576-580.DOI:10.3969/j.issn.1006-5709.2017.05.027.
[32] 王强,杜涛,丁雄.早期进食与标准时机进食治疗急性胰腺炎效果的系统评价[J].重庆医科大学学报, 2016,41(3):292-297. DOI:10.13406/j.cnki.cyxb.000810.
[33] Bevan MG, Asrani VM, Bharmal S, et al.Incidence and Predictors of Oral Feeding Intolerance in Acute Pancreatitis: A Systematic Review, Meta-analysis, and Meta-regression[J]. Clin Nutr,2017,36(3):722-729.DOI:10.1016/j.clnu.2016.06.006.
[34] Krishnan K.Nutritional Management of Acute Pancreatitis[J]. Curr Opin Gastroenterol,2017,33(2):102-106. DOI:10.1097/MOG.0000000000000340.
[35] Petrov MS.Gastric feeding and “Gut Rousing” in Acute Pancreatitis[J]. Nutr Clin Pract,2014, 29(3):287-290.DOI:10.1177/0884533614528986.
[36] Stigliano S, Sternby H, de Madaria E, et al. Early Management of Acute Pancreatitis: A Review of the Best Evidence[J].Dig Liver Dis, 2017,49(6):585-594. DOI:10.1016/j.dld.2017.01.168.
[37] 彭昱锦,白学松.急性胰腺炎的肠内营养治疗[J].山东医药, 2016(7):99-101.DOI:10.3969/j.issn.1002-266X.2016.07.039.
[38] 窦晓坛,邹晓平.急性胰腺炎的营养管理[J].胃肠病学,2014,19(6):321-323. DOI:10.3969/j.issn.1008-7125.2014.06.001.
[39] 魏星,李文星.急性胰腺炎诊疗新进展及营养支持研究[J].中华临床医师杂志(电子版),2016,10(7):1037-1041. DOI:10.3877/cma.j.issn.1674-0785.2016.07.028.
[40] Li J, Xue GJ, Liu YL, et al.Early Oral Refeeding Wisdom in Patients with Mild Acute Pancreatitis[J].Pancreas, 2013,42(1):88-91. DOI:10.1097/mpa.0b013e3182575fb5.
[41] 杨军,秦勤,王田,等.极早期进食对急性胰腺炎病人临床结局的影响[J].肠外与肠内营养,2018,25(5):301-303,307. DOI:10.16151/j.1007-810x.2018.05.011.
[42] Zhao XL, Zhu SF, Xue GJ, et al.Early Oral Refeeding Based on Hunger in Moderate and Severe Acute Pancreatitis:A Prospective Controlled, Randomized Clinical Trial[J].Nutrition,2015,31(1):171-175. DOI:10.1016/j.nut.2014.07.002.
[43] The Agree Next Steps Consortium. Appraisal of Guidelines for Research & Evaluation Ⅱ[EB/OL].(2018-12-01). https://www.agreetrust.org/wp-content/uploads/2017/12/AGREE-II-Users-Manual-and-23-item-Instrument-2009-Update-2017.pdf
[44] 崔世超,侯海燕,李幼平,等.不孕症临床指南的系统评价[J].中国循证医学杂志,2013, 13(8):947-954. DOI:10.7507/1672-2531.20130166.
[45] The Joanna Briggs Institute.JBI Critical Appraisal Checklist for Text and Opinion Papers[EB/OL].(2018-12-22).http://joannabriggs.or/research/critical-appraisal-tools.html.
[46] Better Value Healthcare Ltd(BVHC). Critical Appraisal Skills Programme[EB/OL].(2018-12-25).https://casp-uk.net/wp-content/uploads/2018/01/CASP-Systematic-Review-Checklist_2018.pdf.
[47] Better Value Healthcare Ltd(BVHC).Critical Appraisal Skills Programme[EB/OL].(2018-12-03).https://casp-uk.net/wp-content/uploads/2018/03/CASP-Randomised-Controlled-Trial-Checklist-2018_fillable_form.pdf.
[48] The Joanna Briggs Institute. The Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party Supporting Document for the Joanna Briggs Institute levels of Evidence and Grades of Recommen--dation[EB/OL].(2018-12-20).http://joannabriggs.org/jbi-approach.html#tabbed-nav=Levels-of-Evidence.
[49] 胡雁,郝玉芳. 循证护理学[M]. 2版.北京:人民卫生出版社,2018:52-430.
[50] Windsor AC, Kanwar S, Li AG, et al.Compared with Parenteral Nutrition,Enteral Feeding Attenuates the Acute Phase Response and Improves Disease Severity in Acute Pancreatitis[J].Gut, 1998,42(3):431-435.DOI:10.1097/00042737-199804000-00020.
[51] 王兴鹏,徐敏,许国铭. 2003年全国胰腺疾病学术大会纪要[J].胃肠病学,2004,9(2):113-114. DOI:10.3969/j.issn.1008-7125.2004.02.015.
[52] 许丽丽,杨甲梅,谢峰.快速康复外科在肝胆外科围术期护理中的应用[J].解放军护理杂志,2009,26(6):30-31. DOI:10.3969/j.issn.1008-9993.2009.06.012.
[53] 吴伟鸿,温凌,王巧瑜,等.急性轻型胰腺炎进食营养的临床研究[J].肠外与肠内营养,2009,16(4):212-214. DOI:10.3969/j.issn.1007-810X.2009.04.007.
[54] 卢人玉,彭君.静脉输液护理存在问题及举证责任倒置的思考[J].现代护理,2002,8(11):865-866. DOI:10.3760/cma.j.issn.1674-2907.2002.11.034.
[55] 刘世云. 构建和谐护患关系, 提高患者满意率[J].中国医学理论与实践,2006,16(2):224-225.
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[5] 段方见, 罗羽, 罗春梅, 雷蕾, 谢勤, 解雨. 国内外捐献器官分配的相关实践及思考[J]. 护理学报, 2020, 27(22): 16 -20 .
[6] 张政, 袁理, 孙丽娜, 徐一元, 丁淑贞. 血液透析患者透析间期体质量增加的影响因素研究进展[J]. 护理学报, 2020, 27(22): 21 -25 .
[7] 史博慧, 吕爱莉, 王恋, 郭萍利, 马晓霞, 齐晶. 乳腺癌术后上肢淋巴水肿预防策略的证据总结[J]. 护理学报, 2020, 27(22): 32 -38 .
[8] 李苗苗, 安李一, 陆巍, 王娟, 徐鹏飞. Ⅳ型心肾综合征腹膜透析患者容量管理的最佳证据总结[J]. 护理学报, 2020, 27(22): 39 -44 .
[9] 张世西, 何月月, 尹安春, 黄秀美, 刘思雨. 帕金森病患者照顾者照护体验质性研究的Meta整合[J]. 护理学报, 2020, 27(22): 45 -51 .
[10] 王江宁, 宋梅. 社区女性乳腺癌患者与非乳腺疾病者的情绪管理差异分析[J]. 护理学报, 2020, 27(22): 52 -56 .