择期全麻患者术前禁食禁饮管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.14.013

摘要/Abstract

摘要：

目的检索、评价并整合择期全麻患者术前禁食禁饮管理的最佳证据。方法检索PubMed、Cochrane Library、BMJ Best Practice、Geenmedical、美国国立指南库（National Guideline Clearinghouse,NGC）、国际指南协作网（Guidelines International Network,GIN）、加拿大医学会临床实践指南文库、英国国家卫生与临床优化研究所（National Institute for Health and Care Excellence,NICE）、UpToDate、中国生物医学文献数据库、中国知网、万方数据库、临床指南库以及美国麻醉医师协会、中华医学会麻醉学分会、欧洲麻醉学会、促进术后恢复学会（the Enhanced Recovery After Surgery Society,ERAS）中有关择期全麻患者术前禁食禁饮的所有证据,检索时限为建库至2021年6月。由2名研究者对纳入的文献进行质量评价,并对证据进行提取、整合。结果该研究共纳入20篇文献,其中,指南10篇,证据总结1篇,系统评价4篇,横断面研究1篇,专家共识2篇,随机对照试验2篇,汇总了涉及胃排空机制、风险评估、禁食禁饮方案、教育培训4个类别的17条证据。结论该研究总结了择期全麻患者术前禁食禁饮管理的最佳证据,建议医护人员在了解胃排空机制的前提下,术前对患者进行全面的评估,多学科合作制订术前禁食禁饮方案,以提高医疗护理质量。

关键词: 术前, 禁食, 全麻, 循证护理学, 证据总结

Abstract:

Objective To search,evaluate and integrate the best evidence for preoperative fasting management in patients undergoing elective general anesthesia. Methods PubMed, Cochrane Library, BMJ Best Practice,Geenmedical, NGC, GIN, CMA Infobase, NICE, UpToDate, CBMdisc, CKNI,Wanfang,Clinical guidelines,ASA,Chinese Society of Anesthesiology,European Society of Anesthesiology,and ERAS were searched for evidence of preoperative fasting from database establishment to June 2021. The quality of the included articles was evaluated by 2 investigators,and the evidence was extracted and integrated. Results A total of 20 articles were included in this study,including 10 guidelines,1 evidence summary,4 systematic reviews,1 cross-sectional study,2 expert consensuses and 2 randomized controlled trials,which summarized 17 pieces of evidence involving 4 categories,namely gastric emptying mechanism,risk assessment,fasting protocol,education and training. Conclusion This study summarizes the best evidence of preoperative fasting management in patients undergoing elective general anesthesia,and suggests that medical staff should carry out preoperative comprehensive evaluation under the premise of understanding the mechanism of gastric emptying,and develop preoperative fasting protocols in multidisciplinary collaboration to improve the quality of medical care.

Key words: Preoperative, Fasting, General Anesthesia, Evidence-Based Nursing, Evidence Summary

庄珊珊, 张转运, 傅双, 王江. 择期全麻患者术前禁食禁饮管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(14): 1749-1755.

ZHUANG Shanshan, ZHANG Zhuanyun, FU Shuang, WANG Jiang. Best evidence summary of preoperative fasting management in patients undergoing elective general anesthesia[J]. Chinese Journal of Nursing, 2022, 57(14): 1749-1755.

图/表 5

图1 PubMed的文献检索策略

Figure 1 Literature search strategy of PubMed

图2 文献筛选流程

Figure 2 Flow chart of literature screening

表1 纳入文献的一般情况（n=20）

Table 1 General information of included literature（n=20）

表2 纳入指南的质量评价结果（n=10）

Table 2 The quality evaluation results of the guidelines（n=10）

表3 择期全麻患者术前禁食禁饮管理的最佳证据总结

Table 3 Evidence summary of preoperative fasting management in patients undergoing elective general anesthesia

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