炎症性肠病患者饮食限制体验的质性研究

doi:10.3761/j.issn.0254-1769.2024.01.007

摘要/Abstract

摘要：

目的剖析炎症性肠病患者在饮食限制过程中的真实体验，为护理人员指导患者规范饮食限制行为提供参考。方法采用目的抽样法，选取2022年10月—2023年2月上海市某三级甲等医院消化内科收治的14例炎症性肠病患者进行半结构式深入访谈，使用现象学研究中的Colaizzi 7步分析法进行资料分析。结果共凝练出4个主题、13个亚主题。①存在多重生理挑战：饥饿、营养失衡、疲劳与肌肉衰减。②受负性心理困扰：对美食的渴望与挣扎、对生活的热情减退与焦虑加剧、在社交活动中感到尴尬。③采用多种应对策略：自我饮食调整与适应、采用其他方式来满足口腹之欲、寻求饮食管理相关信息与指导。④收获更多成长与支持：症状与生活质量改善、饮食管理意识增强、饮食管理能力提升、获得同伴与家庭支持。结论炎症性肠病患者的饮食限制体验复杂多样，护理人员应重视患者的营养风险筛查，关注其心理健康，给予患者科学、个性化的饮食指导，并强化社会、家庭支持，以帮助患者更好地进行自我饮食管理。

关键词: 炎症性肠病, 克罗恩病, 溃疡性结肠炎, 饮食限制, 体验, 护理, 质性研究

Abstract:

Objective To analyze the real experiences of patients with inflammatory bowel disease（IBD） during dietary restrictions，providing references for healthcare personnel to guide patients in standardizing dietary restriction behaviors. Methods Purposeful sampling was employed to select 14 patients with IBD who were treated at a tertiary A hospital in Shanghai between October 2022 and February 2023 for semi-structured in-depth interviews. Data were analyzed using the Colaizzi’s 7-step method in phenomenological research. Results 4 themes and 13 sub-themes were extracted. Theme 1：facing multiple physiological challenges（hunger，nutritional imbalance，fatigue and muscle atrophy）. Theme 2：experiencing negative psychological disturbances（craving and struggle for gourmet food，diminished zest for life and increased anxiety，feeling embarrassed during social activities）. Theme 3：adopting various coping strategies（self-adjustment and adaptation to dietary restrictions，satisfying oral desires through various avenues，seeking knowledge and guidance on nutrition）. Theme 4：gaining more growth and support（improved symptom and quality of life，enhanced awareness of dietary health，improved ability to manage diet，receiving support from peers and family）. Conclusion The experience of dietary restrictions in IBD patients is complex and varied. Nursing staff should prioritize nutritional risk screening for IBD patients，pay attention to their mental health，provide patients with scientific and personalized dietary guidance，and strengthen social and family support to assist patients in better self-management of their diet.

Key words: Inflammatory Bowel Diseases, Crohn’s Disease, Ulcerative Colitis, Dietary Restriction, Experience, Nursing Care, Qualitative Research

朱宇倩, 高亚南, 贾俊婉, 杜冰, 雷乐霞, 陈亚梅. 炎症性肠病患者饮食限制体验的质性研究[J]. 中华护理杂志, 2024, 59(1): 50-56.

ZHU Yuqian, GAO Yanan, JIA Junwan, DU Bing, LEI Lexia, CHEN Yamei. Experience of dietary restriction in patients with inflammatory bowel disease： a qualitative study[J]. Chinese Journal of Nursing, 2024, 59(1): 50-56.

图/表 1

参考文献 22

[1]	中华医学会消化病学分会炎症性肠病学组. 炎症性肠病诊断与治疗的共识意见(2018年·北京)[J]. 中国实用内科杂志, 2018, 38(9):796-813. DOI
	The Inflammatory Bowel Disease Group of the Chinese Medical Association’s Gastroenterology Branch. Chinese consensus on diagnosis and treatment of inflammatory bowel disease(Beijing,2018)[J]. Chin J Pract Intern Med, 2018, 38(9):796-813.
[2]	Kaplan GG. The global burden of IBD:from 2015 to 2025[J]. Nat Rev Gastroenterol Hepatol, 2015, 12(12):720-727. DOI
[3]	Lo CH, Lochhead P, Khalili H, et al. Dietary inflammatory potential and risk of Crohn’s disease and ulcerative colitis[J]. Gastroenterology, 2020, 159(3):873-883. DOI URL
[4]	熊欢. 炎症性肠病病人饮食限制行为研究进展[J]. 护理研究, 2022, 36(11):1963-1966.
	Xiong H. Research progress on dietary restriction behavior in patients with inflammatory bowel disease[J]. Chin Nurs Res, 2022, 36(11):1963-1966.
[5]	王昱, 徒文静, 张萍, 等. 炎症性肠病患者饮食限制现况及其饮食限制种类影响因素的多中心研究[J]. 中国全科医学, 2022, 25(6):663-668.
	Wang Y, Tu WJ, Zhang P, et al. Prevalence and associated factors of kinds of dietary restrictions in patients with inflammatory bowel disease:a multicenter study[J]. Chin Gen Pract, 2022, 25(6):663-668.
[6]	周云仙, 陈焰. 炎症性肠病患者饮食调查与分析[J]. 中华护理杂志, 2013, 48(10):914-916.
	Zhou YX, Chen Y. Investigation and analysis on diet of patients with inflammatory bowel disease[J]. Chin J Nurs, 2013, 48(10):914-916
[7]	Edward KL, Welch T. The extension of Colaizzi’s method of phenomenological enquiry[J]. Contemp Nurse, 2011, 39(2):163-171.
[8]	Moran GW, Thapaliya G. The gut-brain axis and its role in controlling eating behavior in intestinal inflammation[J]. Nu-trients, 2021, 13(3):981.
[9]	Massironi S, Viganò C, Palermo A, et al. Inflammation and malnutrition in inflammatory bowel disease[J]. Lancet Gastroenterol Hepatol, 2023, 8(6):579-590. DOI URL
[10]	中华医学会消化病学分会炎症性肠病学组. 炎症性肠病营养支持治疗专家共识(第二版)[J]. 中华炎性肠病杂志, 2018, 2(3):154-172.
	The Inflammatory Bowel Disease Group of the Chinese Medical Association’s Gastroenterology Branch. Expert consensus on nutritional support therapy for inflammatory bowel disease(second edition)[J]. Chin J Inflamm Bowel Dis, 2018, 2(3):154-172.
[11]	Batsis JA, Villareal DT. Sarcopenic obesity in older adults:aetiology,epidemiology and treatment strategies[J]. Nat Rev Endocrinol, 2018, 14(9):513-537. DOI PMID
[12]	李苗苗, 熊宇, 罗健. 炎症性肠病患者营养支持的最佳证据总结[J]. 中华护理杂志, 2021, 56(9):1394-1401. DOI URL
	Li MM, Xiong Y, Luo J. Evidence summary of nutritional support in patients with inflammatory bowel disease[J]. Chin J Nurs, 2021, 56(9):1394-1401. DOI URL
[13]	Sood A, Ahuja V, Kedia S, et al. Diet and inflammatory bowel disease:the Asian Working Group guidelines[J]. Indian J Gastroenterol, 2019, 38(3):220-246. DOI
[14]	余姜璇, 单雪琪, 王俊杰, 等. 老年肌少症患者营养管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(18):2261-2268.
	Yu JX, Shan XQ, Wang JJ, et al. Best evidence summary for nutrition management in elderly patients with sarcopenia[J]. Chin J Nurs, 2022, 57(18):2261-2268.
[15]	Firth J, Gangwisch JE, Borisini A, et al. Food and mood:how do diet and nutrition affect mental wellbeing?[J]. BMJ, 2020, 369:m2382.
[16]	Wardle RA, Thapaliya G, Nowak A, et al. An examination of appetite and disordered eating in active Crohn’s disease[J]. J Crohns Colitis, 2018, 12(7):819-825. DOI URL
[17]	Wynne B, McHugh L, Gao W, et al. Acceptance and commitment therapy reduces psychological stress in patients with inflammatory bowel diseases[J]. Gastroenterology, 2019, 156(4):935-945. DOI PMID
[18]	Whelan K, Murrells T, Morgan M, et al. Food-related quality of life is impaired in inflammatory bowel disease and associated with reduced intake of key nutrients[J]. Am J Clin Nutr, 2021, 113(4):832-844. DOI PMID
[19]	Rines J, Daley K, Loo S, et al. A patient-led,peer-to-peer qualitative study on the psychosocial relationship between young adults with inflammatory bowel disease and food[J]. Health Expect, 2022, 25(4):1486-1497. DOI URL
[20]	Zallot C, Quilliot D, Chevaux JB, et al. Dietary beliefs and behavior among inflammatory bowel disease patients[J]. Inflamm Bowel Dis, 2013, 19(1):66-72. DOI PMID
[21]	周美景, 罗丹, 林征, 等. 炎症性肠病患者自我管理行为的影响因素分析[J]. 中华护理杂志, 2021, 56(4):550-555. DOI URL
	Zhou MJ, Luo D, Lin Z, et al. Analysis of influencing factors of self-management behavior in patients with inflammatory bowel disease[J]. Chin J Nurs, 2021, 56(4):550-555. DOI URL
[22]	丁春戈, 梅永霞, 林蓓蕾, 等. 二元应对在慢性病患者及其配偶中的应用进展[J]. 中华护理杂志, 2018, 53(5):626-630.
	Ding CG, Mei YX, Lin BL, et al. Application progress of binary coping in patients with chronic diseases and their spouses[J]. Chin J Nurs, 2018, 53(5):626-630.