食管癌术后患者肠内营养相关性腹泻管理流程的制订与应用

doi:10.3761/j.issn.0254-1769.2024.03.013

摘要/Abstract

摘要：

目的制订食管癌术后患者肠内营养相关性腹泻管理流程并探究应用效果。方法在文献检索和专家会议基础上，构建食管癌术后患者肠内营养相关性腹泻管理流程。采用便利抽样法，选取江苏省某三级甲等肿瘤医院胸外科食管癌术后并发肠内营养相关性腹泻的患者68例，其中2022年1月—12月入院的患者作为试验组，按照食管癌术后肠内营养相关性腹泻管理流程进行管理；2021年1月—12月入院的患者作为对照组，接受常规护理。比较两组止泻时间、腹泻评分、营养评价相关指标、电解质紊乱（低钠、低钾、低钙）发生率的差异。结果试验组止泻时间、干预3 d后腹泻评分、目标喂养量达标时间均低于对照组，差异具有统计学意义（P<0.05）；两组干预3 d后的血红蛋白、白蛋白、前白蛋白水平，干预3 d后电解质紊乱发生率及干预7 d后的体重指数比较，差异均无统计学意义（P>0.05）。结论实施肠内营养相关性腹泻管理流程能够缩短食管癌术后患者腹泻时间，改善腹泻严重程度，更快实现目标喂养量，但对电解质紊乱发生率无明显改变。

关键词: 食管癌, 肠内营养, 腹泻, 流程管理, 护理

Abstract:

Objective To explore the application effect of enteral nutrition-related diarrhea in postoperative esophageal cancer patients. Methods Based on literature search and expert meeting，a management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients was constructed. A convenience sampling method was used to select a total of 68 patients with enteral nutrition-related diarrhea after esophageal cancer surgery admitted to the thoracic surgery department of a tertiary A cancer hospital in Jiangsu Province. Among them，patients admitted from January 2022 to December 2022 were set as an experimental group. The experimental group was implemented the management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients. Those admitted from January 2021 to December 2021 were set as a control group with routine nursing. Then，the time of stopping diarrhea，the King’s of Stool Chart（KSC-Tr） diarrhea score，and abnormal incidence of nutrition-related indexes，electrolytes abnormalities（low sodium，low potassium，and low calcium） were compared between 2 groups. Results The time of stopping diarrhea，KSC diarrhea score after 3 days of intervention and the time to achieve target feeding volume of the experimental group were lower than those in the control group，and the difference was statistically significant（P<0.05）. There were no significant differences in hemoglobin，albumin，prealbumin after 3 days of intervention，the incidence of electrolyte abnormalities（low sodium，low potassium，and low calcium） after 3 days of intervention，and the BMI index after 7 days of intervention between 2 groups（P>0.05）. Conclusion The management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients can reduce the time of diarrhea，improve the severity of diarrhea，and shorten the time to achieve the target feeding，but has no significant change in the incidence of electrolyte abnormalities.

Key words: Esophageal Cancer, Enteral Nutrition, Diarrhea, Process Management, Nursing Care

吴白女, 米元元, 郑义, 张柳柳, 章毛毛, 邾萍, 刘春丽, 吴冰, 羌燕. 食管癌术后患者肠内营养相关性腹泻管理流程的制订与应用[J]. 中华护理杂志, 2024, 59(3): 338-344.

WU Bainü, MI Yuanyuan, ZHENG Yi, ZHANG Liuliu, ZHANG Maomao, ZHU Ping, LIU Chunli, WU Bing, QIANG Yan. Construction and application of a management process for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients[J]. Chinese Journal of Nursing, 2024, 59(3): 338-344.

图/表 6

表1 食管癌术后患者肠内营养相关性腹泻管理的最佳证据汇总

Table 1 Summary of best evidence for enteral nutrition-associated diarrhea in postoperative esophageal cancer patients

图1 食管癌术后患者肠内营养相关性腹泻管理流程图注：KSC-Tr为腹泻评估工具（the King’s of Stool Chart）。

Figure 1 Flow chart for management of enteral nutrition-associated diarrhea in postoperative esophageal cancer patients

表2 两组一般资料的比较

Table 2 Comparison of general data between 2 groups

表3 两组止泻时间和腹泻评分比较（$ \bar{x} \pm s$）

Table 3 Comparison of diarrhea stopping time and KSC-Tr diarrhea score between 2 groups（$ \bar{x} \pm s$）

表4 两组干预后营养评价相关指标及目标喂养量达标时间比较（$ \bar{x} \pm s$）

Table 4 Comparison of nutritional related indicators and time to achieve target feeding volume between 2 groups（$ \bar{x} \pm s$）

表5 两组干预3 d后电解质紊乱发生率比较 [例（百分比，%）]

Table 5 Comparison of the incidence of electrolyte abnormalities after 3 days intervention between 2 groups [cases（percentage，%）]

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