直肠癌支架法肠转流术患者围手术期口服营养补充方案的构建及应用

doi:10.3761/j.issn.0254-1769.2026.16.002

中华护理杂志 ›› 2026, Vol. 61 ›› Issue (16): 2174-2181.DOI: 10.3761/j.issn.0254-1769.2026.16.002

• 消化系统疾病护理专题 • 上一篇下一篇

直肠癌支架法肠转流术患者围手术期口服营养补充方案的构建及应用

鲜雪梅¹(), 匡园园¹, 朱陈萍¹, 王雪², 孔炜¹, 李燕¹, 王勇珍¹, 郭幸玥¹, 庄一渝¹^,^*()

¹ 浙江大学医学院附属邵逸夫医院护理部杭州市 310016
² 杭州市第一人民医院护理部杭州市 310000

收稿日期:2026-02-04 出版日期:2026-08-20 发布日期:2026-08-14
*通讯作者: 庄一渝，E-mail：zhuangyy@zju.edu.cn
作者简介:鲜雪梅：女，硕士，副主任护师，护士长，E-mail：xianxuemei@zju.edu.cn
第一联系人：作者贡献声明
鲜雪梅：研究设计、干预方案构建、论文撰写；匡园园：干预方案构建及实施、患者随访；朱陈萍：研究设计、干预方案构建；王雪：干预方案构建；孔炜：干预实施、患者随访；李燕、王勇珍、郭幸玥：数据收集及分析；庄一渝：研究指导、论文审阅与修改

Construction and application of a refined perioperative oral nutritional supplement management for the stent-based diverting technique of rectal cancer

XIAN Xuemei¹(), KUANG Yuanyuan¹, ZHU Chenping¹, WANG Xue², KONG Wei¹, LI Yan¹, WANG Yongzhen¹, GUO Xingyue¹, ZHUANG Yiyu¹^,^*()

¹ Nursing Department， Sir Run Run Shaw Hospital，Zhejiang University School of Medicine， Hangzhou 310016， China
² Nursing Department， Hangzhou First People’s Hospital， Hangzhou 310000， China

Received:2026-02-04 Online:2026-08-20 Published:2026-08-14
* Corresponding author: ZHUANG Yiyu， E-mail：zhuangyy@zju.edu.cn

摘要/Abstract

摘要：

目的构建直肠癌支架法肠转流术患者围手术期口服营养补充方案，并验证其临床应用效果，为直肠癌患者围手术期营养管理提供参考。方法在最佳证据总结的基础上，结合半结构式访谈结果，并通过专家会议构建直肠癌支架法肠转流术患者围手术期口服营养补充方案。采用便利抽样法，选取2024年1月—2025年6月杭州市某三级甲等综合医院收治的直肠癌支架法肠转流术患者65例作为试验组，2022年7月—2023年12月纳入的65例为对照组。试验组实施口服营养补充方案，对照组实施常规营养健康教育和护理。比较两组术后营养不良的发生率、口服营养补充治疗依从率、血红蛋白及白蛋白浓度的变化趋势、胃肠不耐受发生率及并发症发生率的差异。结果干预期间，共脱落5例，最终试验组纳入61例，对照组纳入64例。术后1个月，试验组营养不良的发生率低于对照组，试验组口服营养补充治疗依从率高于对照组，差异具有统计学意义（P<0.05）；术后两组血红蛋白和白蛋白浓度均呈先下降后逐渐恢复的趋势，将术前值作为协变量进行基线校正，各时间点试验组校正后均值高于对照组，且术后第7天和术后1个月两组校正后均值差异有统计学意义（P<0.05）；两组胃肠不耐受和并发症发生率差异无统计学意义（P>0.05）。结论该研究构建的直肠癌支架法肠转流术患者围手术期口服营养补充方案具有较好的科学性和可行性，能够提高患者服用口服营养补充治疗依从率、降低术后营养不良发生率，促进术后白蛋白和血红蛋白浓度恢复，且不增加胃肠不耐受和常见并发症的发生率。

关键词: 直肠癌, 可降解肠道支架, 围手术期, 口服营养补充, 护理

Abstract:

Objective To develop a perioperative oral nutritional supplementation（ONS） protocol for rectal cancer patients undergoing stent-based diverting technique（SDT） and to evaluate its efficacy，providing a reference for the perioperative nutritional management of patients with rectal cancer. Methods Based on the best evidence and qualitative interviews on patient needs，a perioperative ONS protocol for rectal cancer patients undergoing SDT was developed and finalized by an expert consensus meeting. A total of 130 patients who underwent SDT for rectal cancer at a tertiary A comprehensive hospital in Hangzhou，China，from July 2022 to June 2025 were enrolled through convenience sampling. Patients admitted between January 2024 and June 2025（n=65） were assigned to an intervention group，while those admitted between July 2022 and December 2023（n=65） served as a historical control group. The intervention group received this protocol，whereas the control group received standard nutritional education and routine nursing care. The differences in the incidence of malnutrition，the compliance rate of taking ONS，the changing trends of hemoglobin and albumin，and the incidence rates of gastrointestinal intolerance and complications at 1 month after operation were compared between the 2 groups. Results During the intervention，a total of 5 cases dropped out. Finally，61 cases were included in the intervention group and 64 cases in the control group. A month after surgery，the incidence of malnutrition in the intervention group was lower than that in the control group（P<0.05）. The adherence to ONS was significantly higher in the intervention group compared with the control group（P<0.05）. After the operation，the concentrations of hemoglobin and albumin in both groups showed a trend of early decline followed by a slow recovery. The preoperative values were used as covariates for baseline correction，and the adjusted mean values of hemoglobin and albumin in the intervention group at each time point after surgery were higher than those in the control group，and the differences were statistically significant at 7 days and 1 month after surgery（P<0.05）. No statistically significant differences were observed between the 2 groups in the rates of gastrointestinal intolerance or postoperative complications（P>0.05）. Conclusion The perioperative ONS protocol for rectal cancer patients undergoing SDT developed in this study demonstrates scientific and practical value. This protocol can reduce the incidence of postoperative malnutrition，promote the recovery of albumin and hemoglobin，and does not increase the incidence of gastrointestinal intolerance and common complications.

Key words: Rectal Cancer, Stent-Based Diverting Technique, Perioperative Period, Oral Nutritional Supplement, Nursing Care

鲜雪梅, 匡园园, 朱陈萍, 王雪, 孔炜, 李燕, 王勇珍, 郭幸玥, 庄一渝. 直肠癌支架法肠转流术患者围手术期口服营养补充方案的构建及应用[J]. 中华护理杂志, 2026, 61(16): 2174-2181.

XIAN Xuemei, KUANG Yuanyuan, ZHU Chenping, WANG Xue, KONG Wei, LI Yan, WANG Yongzhen, GUO Xingyue, ZHUANG Yiyu. Construction and application of a refined perioperative oral nutritional supplement management for the stent-based diverting technique of rectal cancer[J]. Chinese Journal of Nursing, 2026, 61(16): 2174-2181.

图/表 5

表1 直肠癌支架法肠转流术患者围手术期口服营养补充方案

Table 1 Perioperative ONS management for the SDT of rectal cancer patients

表2 两组一般资料的比较

Table 2 Comparison of general data between the 2 groups

表3 两组口服营养补充治疗依从率的比较

Table 3 Comparison of the compliance rate of taking ONS between the 2 groups

表4 两组各时间点血红蛋白校正后估算边际均值的比较（g/L）

Table 4 Comparison of the estimated marginal mean of postoperative hemoglobin between the 2 groups（g/L）

表5 两组各时间点白蛋白校正后估算边际均值的比较（g/L）

Table 5 Comparison of the estimated marginal mean of the postoperative albumin between the 2 groups（g/L）

参考文献 22

[1]	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3):229-263.
[2]	杨莹, 张雪, 冯磊. 中低位直肠癌保肛术后患者排便功能调查及其与生活质量的相关性分析[J]. 中国肛肠病杂志, 2024, 44(8):33-35.
	Yang Y, Zhang X, Feng L. Investigation of defecation function and its correlation with quality of life in patients with middle and low rectal cancer after anal preservation[J]. Chin J Coloproctology, 2024, 44(8):33-35.
[3]	Song ZF, Huang XF, Dai S, et al. A stent-based diverting technique after low anterior resection of rectal cancer:our preliminary experience[J]. Langenbecks Arch Surg, 2022, 407(4):1751-1756. DOI
[4]	Clinical Trials. The safety and efficiency of stent-based diverting technique versus ileostomy in rectal cancer patients:a prospec-tive,multicenter,open-label,non-inferiority,randomized controlled study[EB/OL]. (2024-01-12)[2025-12-10]. https://clinicaltrials.gov/study/NCT06204497.
[5]	李瑞华, 甄莉, 朱木兰, 等. 预防性回肠造口患者营养状况及影响因素分析[J]. 中华护理杂志, 2025, 60(4):396-403. DOI
	Li RH, Zhen L, Zhu ML, et al. Nutritional status and influencing factors in patients undergoing preventive ileostomy[J]. Chin J Nurs, 2025, 60(4):396-403. DOI
[6]	王雪, 陈力, 匡园园, 等. 支架法转流术在低位直肠癌前切除术中的应用[J]. 农垦医学, 2024, 46(4):319-322,339.
	Wang X, Chen L, Kuang YY, et al. Application of stent bypass in anterior resection of low rectal cancer[J]. J Nongken Med, 2024, 46(4):319-322,339.
[7]	中华医学会外科学分会结直肠外科学组. 中国结直肠癌手术病人营养治疗指南(2025 版)[J]. 中国实用外科杂志, 2025, 45(2):7137-7148.
	Chinese Society of Colorectal Surgery,Chinese Society of Surgery,Chinese Medical Association. China nutritional therapy guidelines for colorectal cancer surgery patients(2025 edition)[J]. Chin J Pract Surg 2025, 45(2):7137-7148.
[8]	王雪, 韦丁元, 王梦星, 等. 基于信息-动机-行为技巧模型探讨直肠癌支架法肠转流术后患者饮食管理现状的质性研究[J]. 中国实用护理杂志, 2024, 40(16):1268-1274.
	Wang X, Wei DY, Wang MX, et al. A qualitative study of diet management in patients with colorectal cancer after stent-based diverting technique based on information-motivation-behavioral skills model[J]. Chin J Pract Nurs, 2024, 40(16):1268-1274.
[9]	Hedrick TL, McEvoy MD, Mythen MMG, et al. American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative gastrointestinal dysfunction within an enhanced recovery pathway for elective colorectal surgery[J]. Anesth Analg, 2018, 126(6):1896-1907. DOI PMID
[10]	中华医学会肠外肠内营养学分会. 中国成人患者肠外肠内营养临床应用指南(2023版)[J]. 中华医学杂志, 2023, 103(13):946-974.
	Chinese Society of Parenteral and Enteral Nutrition(CSPEN). Guideline for clinical application of parenteral and enteral nutrition in adults patients in China(2023 edition)[J]. Natl Med J China, 2023, 103(13):946-974.
[11]	Habibi S, Talebi S, Khosravinia D, et al. Oral nutritional supplementation in cancer patients:a systematic review and dose-response meta-analysis[J]. Clin Nutr, 2025, 47:28-39. DOI URL
[12]	吴蓓雯, 叶向红, 李素云, 等. 提高口服营养补充依从性临床管理实践的专家共识[J]. 肿瘤代谢与营养电子杂志, 2021, 8(5):487-494.
	Wu BW, Ye XH, Li SY, et al. Expert consensus on improving the compliance to oral nutritional supplements in clinical practice[J]. Electron Jourmal Metab Nutr Cancer, 2021, 8(5):487-494.
[13]	刘莹, 李婷, 侯海燕, 等. 营养专科护士主导的目标执行管理模式对胃肠道肿瘤病人围术期口服营养补充依从性的效果研究[J]. 肠外与肠内营养, 2023, 30(3):160-165.
	Liu Y, Li T, Hou HY, et al. The effect of nutrition specialist nurse-led target execution management mode on perioperative oral nutritional supplement compliance in patients with gastrointestinal tumors[J]. Parenter Enter Nutr, 2023, 30(3):160-165.
[14]	Chen YL, Xian XM, Zhu CP, et al. Compliance analysis of oral nutritional supplements in hospitalized postsurgical patients with colorectal cancer:a prospective study[J]. J Clin Nurs, 2025, 34(4):1375-1382. DOI URL
[15]	毕淑敏, 姚远远, 范云珊, 等. 全程营养教育方案在胰十二指肠切除术患者中的应用研究[J]. 中华护理杂志, 2025, 60(15):1871-1878. DOI
	Bi SM, Yao YY, Fan YS, et al. A study of a comprehensive nutrition education program in patients undergoing pancreaticoduodenectomy[J]. Chin J Nurs, 2025, 60(15):1871-1878. DOI
[16]	韩萌, 王莎莎, 李宇恒, 等. 围手术期结直肠癌患者营养治疗的研究进展[J]. 肿瘤代谢与营养电子杂志, 2024, 11(1):123-129.
	Han M, Wang SS, Li YH, et al. A literature review of research progress in nutritional therapy for perioperative colorectal cancer patients[J]. Electron J Metab Nutr Cancer, 2024, 11(1):123-129.
[17]	Lobo DN, Gianotti L, Adiamah A, et al. Perioperative nutrition:recommendations from the ESPEN expert group[J]. Clin Nutr, 2020, 39(11):3211-3227. DOI URL
[18]	Elia M, Normand C, Norman K, et al. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting[J]. Clin Nutr, 2016, 35(2):370-380. DOI PMID
[19]	熊照玉, 柯卉, 李素云, 等. 围手术期患者口服营养补充的最佳证据总结[J]. 中华护理杂志, 2021, 56(2):283-288. DOI
	Xiong ZY, Ke H, Li SY, et al. Evidence summary of oral nutritional supplements in perioperative patients[J]. Chin J Nurs, 2021, 56(2):283-288. DOI
[20]	赵莹莹, 朱利华. 基于胃肠功能动态评估的阶梯式肠内营养方案与固定方案对ICU重症脑卒中患者耐受性及并发症的影响[J]. 中国药物滥用防治杂志, 2025, 31(10):1824-1826,1838.
	Zhao YY, Zhu LH. Effect of stepwise enteral nutrition regimen and fixed regimen based on dynamic assessment of gastrointestinal function on tolerance and complications in ICU patients with severe stroke[J]. Chin J Drug Abuse Prev Treat, 2025, 31(10):1824-1826,1838.
[21]	孙倩, 刘蓓, 朱华媛. 结直肠癌患者术后发生胃肠功能障碍的危险因素分析及预测模型构建[J]. 结直肠肛门外科, 2025, 31(1):45-54.
	Sun Q, Liu B, Zhu HY. Analysis of risk factors for postoperative gastrointestinal dysfunction in colorectal cancer patients and construction of a predictive model[J]. J Colorectal Anal Surg, 2025, 31(1):45-54.
[22]	Cunha T, Miguel S, Maciel J, et al. Surgical site infection prevention care bundles in colorectal surgery:a scoping review[J]. J Hosp Infect, 2025, 155:221-230. DOI URL

直肠癌支架法肠转流术患者围手术期口服营养补充方案的构建及应用

Construction and application of a refined perioperative oral nutritional supplement management for the stent-based diverting technique of rectal cancer

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 22

相关文章 15

编辑推荐

Metrics

[1]	中华护理学会静脉输液治疗专业委员会, 北京护理学会, （执笔：李佳, 李旭英, 覃惠英, 陈利芬, 吴珍明, 胡泽吟, 罗梦娜, 范育英, 吴嘉慧, 林宇萍, 王蕾, 孙文彦, 冯毕龙, 高伟, 李亚南, 侯罗娅, 李春燕. 中心静脉通路装置拔除护理专家共识[J]. 中华护理杂志, 2026, 61(9): 1157-1162.
[2]	周霞, 马艳艳, 师正坤, 于海霞, 周艳, 胡红玲, 李莜, 陈思思, 张京慧. 隧道式经股静脉PICC置入术在困难静脉通路婴幼儿中的应用研究[J]. 中华护理杂志, 2026, 61(9): 1163-1170.
[3]	黄萍, 李黎, 郭骊莉, 徐莹, 叶赟, 江淑芳. 与无针输液接头相关的导管相关性血流感染风险评估工具的构建与初步应用[J]. 中华护理杂志, 2026, 61(9): 1171-1179.
[4]	李佳, 张玉玲, 邢乐, 张利峰, 牛秀峰, 许莉. 早产儿经上肢置入PICC尖端继发性异位风险预测模型的建立与验证[J]. 中华护理杂志, 2026, 61(9): 1180-1186.
[5]	何娟, 赵蕾蕾, 叶冠军, 余艳芬, 傅晓君, 周琴. 1例双侧无名静脉及上腔静脉人工血管置换术后患者经上肢置入PICC的护理[J]. 中华护理杂志, 2026, 61(9): 1187-1191.
[6]	梁江淑渊, 曾妃, 何鹏, 谢梦珊, 江悦, 蒋宗恒, 王建茗. 静脉-静脉体外膜肺氧合患者早期活动风险等级评估系统的构建及应用研究[J]. 中华护理杂志, 2026, 61(9): 1192-1199.
[7]	陈晨, 顾肖, 郭凡, 王敏, 倪兴梅, 黄琴, 程念开. 3种衰弱评估工具对急诊老年创伤患者不良结局的预测价值[J]. 中华护理杂志, 2026, 61(9): 1200-1207.
[8]	郑煜琳, 刘晋宁, 张静, 郭会敏, 谷艳梅, 张莉莉. 酒精性肝病患者肝移植术后再饮酒现状及其影响因素分析[J]. 中华护理杂志, 2026, 61(9): 1208-1214.
[9]	叶俊霜, 沈丽佳, 孟霞靓, 张玉姣, 蔡根莲, 邵碧云, 周亚辉, 张柳倩, 应金萍. 维持性血液透析患者对口腔衰弱认知和体验的质性研究[J]. 中华护理杂志, 2026, 61(9): 1215-1220.
[10]	王芸姣, 杨玉金, 郑春艳, 彭菲津, 王淑贞, 蒋喜露, 周为民, 王薇, 张娜. 糖尿病下肢动脉硬化闭塞症患者介入术后康复护理方案的构建及应用研究[J]. 中华护理杂志, 2026, 61(9): 1221-1229.
[11]	杨明霞, 安冉, 臧金凤, 李春梅. 老年慢性病共病患者及照护者老老照护能力与自我忽视的相关性分析[J]. 中华护理杂志, 2026, 61(9): 1230-1236.
[12]	梁和静, 许鹊, 史云霞, 祖金美, 黄文静, 杨春旭, 郭明华, 王磊. 颈动脉内膜剥脱术围手术期护理质量评价指标的构建[J]. 中华护理杂志, 2026, 61(9): 1237-1244.
[13]	韩媛媛, 石玉竹, 尚文涵, 么莉. 870所三级甲等医院老年住院患者跌倒伤害发生现状与影响因素分析[J]. 中华护理杂志, 2026, 61(9): 1245-1252.
[14]	夏云芳, 王洪, 崔岱, 付真真, 朱敏. 1例弥漫性毒性甲状腺肿合并超敏反应综合征青少年患者的护理[J]. 中华护理杂志, 2026, 61(9): 1253-1256.
[15]	周益飞, 王海苹, 胡益环, 应莉, 罗松娜. 1例氢氟酸中毒并发呼吸心搏骤停患者的急救护理[J]. 中华护理杂志, 2026, 61(9): 1257-1260.