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护理学报 ›› 2021, Vol. 28 ›› Issue (17): 70-75.doi: 10.16460/j.issn1008-9969.2021.17.070

• 临床护理:外科护理 • 上一篇    下一篇

构建住院患者肠内营养相关便秘预警分级标准及干预方案

熊照玉1a, 李素云1b, 杨赛1c, 柯卉1d, 黄海燕1e, 周慧敏1a, 晏蓉1f, 刘云访1g, 刘天艺2   

  1. 1.华中科技大学同济医学院附属协和医院 a.乳甲外科;b.外科;c.胃肠外科;d.肝胆外科;e.重症医学科;f.骨科;g.胸外科,湖北 武汉 430022;
    2.华中科技大学同济医学院 护理学院,湖北 武汉 430022
  • 收稿日期:2021-05-18 发布日期:2021-10-12
  • 通讯作者: 李素云(1977-),女,湖北武汉人,博士,主任护师,外科总护士长。E-mail:lisuyun0503@163.com
  • 作者简介:熊照玉(1992-),女,湖北钟祥人,硕士,护师。
  • 基金资助:
    2017湖北省技术创新专项(软科学研究)(2017ADC077)

Construction of Evidence-based Early Warning Grading Standard and Interventions for Enteral Nutrition-related Constipation in Inpatients

XIONG Zhao-yu1a, LI Su-yun1b, YANG Sai1c, KE Hui1d, HUANG Hai-yan1e, ZHOU Hui-Min1a, YAN Rong1f, LIU Yun-Fang1g, LIU Tian-Yi2   

  1. 1a. Dept. of Breast and Thyroid Surgery; 1b. Dept. of Surgery; 1c. Dept. of Gastrointestinal Surgery; 1d. Dept. of Hepatobiliary Surgery; 1e. Dept. of Critical Care Medicine, 1f. Dept. of Orthopedics, 1g. Dept. of Thoracic Surgery, Union Hospital, Tongji Medical College of Huangzhong University of Science and Technology, Wuhan 430022, China;
    2. School of Nursing, Tongji Medical College of Huangzhong University of Science and Technology, Wuhan 430022, China
  • Received:2021-05-18 Published:2021-10-12

摘要: 目的 构建肠内营养相关便秘预警分级标准及干预方案。方法 基于循证,结合临床实践,通过专家会议法初步设定咨询内容,运用德尔菲法进行2轮专家函询,确立了最终方案。结果 2轮函询中专家的积极系数均为100%,权威系数分别为0.866、0.902,肯德尔和谐系数为0.139、0.301。最终确立了肠内营养相关便秘预警分级标准及干预方案,包括5级便秘预警分级及17项干预措施。结论 构建的肠内营养相关便秘预警分级标准及干预方案具有一定的科学性和可靠性,为护理肠内营养患者提供了参考依据。

关键词: 肠内营养, 便秘, 预警, 分级标准, 干预, 循证护理, 德尔菲法

Abstract: Objective To construct early warning grading standard and interventions for enteral nutrition-related constipation in inpatients. Methods Based on evidence-based methodology and combined with clinical practice, the consultation content was preliminarily set by expert meeting, and the final scheme was established after two rounds of expert letter consultation by Delphi method. Results In the two rounds of correspondence consultation, the positive coefficient of experts was all 100%; the authority coefficients were 0.866 and 0.902 respectively, and the Kendall harmony coefficients were 0.139 and 0.301, respectively. Early warning grading standard and interventions for enteral nutrition-related constipation were constructed, including five-level constipation warning classifications and 17 interventions. Conclusion The early warning grading standard and interventions for enteral nutrition-related constipation constructed are scientific and reliable, providing reference for nursing enteral nutrition patients.

Key words: enteral nutrition, constipation, early warning, grading standard, intervention, evidence-based nursing, Delphi method

中图分类号: 

  • R473.57
[1] Herbert G,Perry R,Andersen HK,et al.Early Enteral Nutrition within 24 Hours of Lower Gastrointestinal Surgery Versus Later Commencement for Length of Hospital Stay and Postoperative Complications[J]. Cochrane Database Syst Rev,2019,7(7):CD004080.DOI:10.1002/14651858.CD004080.pub4.
[2] Akobeng AK, Zhang D, Gordon M, et al. Enteral Nutrition for Maintenance of Remission in Crohn's Disease[J]. Cochrane Database Syst Rev,2018,8(8):CD005984. 10.1002/14651858.CD005984.pub3.
[3] Pitta MR, Campos FM, Monteiro AG, et al.Tutorial on Diarrhea and Enteral Nutrition: A Comprehensive Step-by-step Approach[J]. J Parenter Enteral Nutr, 2019, 43(8):1008-1019. DOI:10.1002/jpen.1674.
[4] Yuan Y, Zhao Y, Xie T, et al. Percutaneous Endoscopic Gastrostomy Versus Percutaneous Radiological Gastrostomy for Swallowing Disturbances[J].Cochrane Database Syst Rev, 2016,2(2):CD009198.DOI:10.1002/14651858.CD009198.pub2.
[5] Steenhagen E.Enhanced Recovery After Surgery: It's Time to Change Practice![J]. Nutr Clin Pract, 2016, 31(1):18-29.DOI:10.1177/0884533615622640.
[6] Puett L, Bsn RN, Smith L, et al.Feasibility of Enhanced Recovery Protocols in Children[J].J Pediatr Surg Nurs, 2018, 7(1):9-19. DOI:10.1097/JPS.0000000000000159.
[7] Billson HA, Holland C, Curwell J, et al. Perioperative Nutrition Interventions for Women with Ovarian Cancer[J]. Cochrane Database Syst Rev, 2013,11(9):CD009884.DOI:10.1002/14651858.cd009884.pub2.
[8] Baron TH, DiMaio CJ, Wang AY, et al. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis[J]. Gastroenterology, 2020, 158(1):67-75. DOI:10.1053/j.gastro.2019.07.064.
[9] 周荃,黄素芳.主动脉夹层病人便秘影响因素及护理措施研究进展[J]. 护理研究, 2020, 34(10):1745-1749. DOI:10.12102/j.issn.1009-6493.2020.10.012.
[10] 李旭英,谌永毅,石汉平,等. 化疗不良反应预警系统的构建及应用进展[J].中华护理杂志, 2019, 54(5):760-764. DOI:10.3761/j.issn.0254-1769.2019.05.028.
[11] 张灵芳,赵明利,张雪葳,等. 产前护理风险预警评估工具的研究进展[J]. 中国实用护理杂志, 2018,34(8):633-636. DOI:10.3760/cma.j.issn.1672-7088.2018.08.016.
[12] 旷小羿,侯惠如. 基于电子病历数据的风险预测模型在临床护理中的应用现状[J]. 护理学报, 2020, 27(16):21-24. DOI:10.16460/j.issn1008-9969.2020.16.021.
[13] 朱政,胡雁,邢唯杰,等.不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994. DOI:10.16821/j.cnki.hsjx.2017.21.025.
[14] 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:10.7326/0003-4819-151-6-200909150-02002.
[15] 王春青,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
[16] Brouwers MC, Kho ME, Browman GP, et al.AGREE II: Advancing Guideline Development, Reporting, and Evaluation in Health Care[J]. Prev Med, 2010, 51(5):421-424. DOI:10.1016/j.ypmed.2010.08.005.
[17] McArthur A, Klugárová J, Yan H,et al. Innovations in the Systematic Review of Text and Opinion[J].Int J Evid Based Healthc,2015,13(3):188-195.DOI:10.1097/XEB.0000000000000060.
[18] Shea BJ, Reeves BC, Wells G, et al.AMSTAR 2: A Critical Appraisal Tool for Systematic Reviews That Include Randomised or Non-randomised Studies of Healthcare Interventions, or Both[J]. BMJ, 2017, 358:j4008. DOI:10.1136/bmj.j4008.
[19] 周英凤,顾莺,胡雁,等.JBI循证卫生保健中心关于不同类型研究的质量评价工具—干预性研究的质量评价[J].护士进修杂志,2018,33(1):24-26. DOI:10.16821/j.cnki.hsjx.2018.01.007.
[20] Dehghan M, Fatehi Poor A, Mehdipoor R, et al.Does Abdominal Massage Improve Gastrointestinal Functions of Intensive Care Patients with an Endotracheal Tube? A Randomized Clinical Trial[J]. Complement Ther Clin Pract, 2018, 30:122-128. DOI:10.1016/j.ctcp.2017.12.018.
[21] Reintam Blaser A, Starkopf J, Alhazzani W, et al.Early Enteral Nutrition in Critically Ill Patients: Esicm Clinical Practice Guidelines[J].Intensive Care Med,2017,43(3):380-398.DOI:10.1007/s00134-016-4665-0.
[22] Reis AMD, Fruchtenicht AV, Loss SH, et al.Use of Dietary Fibers in Enteral Nutrition of Critically Ill Patients: A Systematic Review[J]. Rev Bras Ter Intensiva, 2018, 30(3): 358-365. DOI:10.5935/0103-507X.20180050.
[23] Shin JE, Jung HK, Lee TH, et al.Guidelines for the Diagnosis and Treatment of Chronic Functional Constipation in Korea,2015 Revised Edition[J]. J Neurogastroenterol Motil, 2016, 22(3):383-411. DOI:10.5056/jnm15185.
[24] 陈志林,陈喜,郑盼盼,等. 肠内营养制剂恒温与加温输注对重症脑损伤患者胃肠道并发症的影响[J]. 医学食疗与健康, 2020, 18(8):1-2.
[25] 胡延秋,程云,王银云,等. 成人经鼻胃管喂养临床实践指南的构建[J]. 中华护理杂志, 2016, 51(2):133-141. DOI: 10.3761/j.issn.0254-1769.2016.02.001.
[26] 孙仁华,江荣林,黄曼,等. 重症患者早期肠内营养临床实践专家共识[J]. 中华危重病急救医学, 2018, 30(8):715-721. DOI:10.3760/cma.j.issn.2095-4352.2018.08.001.
[27] 张丽,王莹,李培培,等. 益生菌对危重症肠内营养患者胃肠功能影响的Meta分析[J]. 中华现代护理杂志, 2017, 23(20):2609-2614.DOI:10.3760/cma.j.issn.1674-2907.2017.20.009.
[28] 张思为,周志,山林林,等. 肝胃百合汤对脑卒中后肠内营养患者胃肠道并发症及神经功能评分的影响[J]. 河南中医,2017,37(12):2120-2123.DOI:10.16367/j.issn.1003-5028.2017.12.0728.
[29] Lewis K, Alqahtani Z, McIntyre L, et al. The Efficacy and Safety of Prokinetic Agents in Critically Ill Patients Receiving Enteral Nutrition: A Systematic Review and Meta-analysis of Randomized Trials[J]. Crit Care, 2016, 20(1): 259. DOI:10.1186/s13054-016-1441-z.
[30] 林碧霞,许丽春,杨毅端. 重症鼻饲患者喂养不耐受症状管理的证据总结[J]. 中国护理管理, 2019, 19(2):280-286. DOI:10.3969/j.issn.1672-1756.2019.02.025.
[31] 詹昱新,杨中善,李素云,等. 基于循证构建住院患者肠内营养护理质量评价指标体系[J]. 护理学报, 2019, 27(10): 26-31. DOI:10.16460/j.issn1008-9969.2019.10.026.
[32] Brody F,Vaziri K,Garey C,et al.Preoperative Liver Reduction Utilizing a Novel Nutritional Supplement[J]. J Laparoendosc Adv Surg Tech A, 2011, 21(6):491-495.DOI:10.1089/lap.2010.0559.
[33] 周英凤,胡雁,朱政,等. JBI循证卫生保健模式的更新及发展[J]. 护理学杂志, 2017, 32(3):81-83. DOI:10.3870/j.issn.1001-4152.2017.03.081.
[34] 张磊,张钦铃,聂雪,等. 细节化护理在重症颅脑损伤患者行肠内营养治疗中的应用[J]. 中国实用护理杂志, 2019, 35(15):1151-1154. DOI:10.3969/j.issn.1007-614x.2020.19.087.
[35] 金琳,王伟,李振香. 《护理分级》卫生行业标准实践现状调查研究[J]. 中国实用护理杂志, 2017, 33(13):975-980. DOI:10.3760/cma.j.issn.1672-7088.2017.13.004.
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