消化系统肿瘤患者术后肠内营养相关性腹胀腹泻预防的循证实践

doi:10.3761/j.issn.0254-1769.2026.20.007

中华护理杂志 ›› 2026, Vol. 61 ›› Issue (20): 2787-2794.DOI: 10.3761/j.issn.0254-1769.2026.20.007

消化系统肿瘤患者术后肠内营养相关性腹胀腹泻预防的循证实践

郑美花¹^,^*(), 朱芮¹, 谢宝缘², 陈飞燕¹, 黄桂云¹, 王璐祯¹, 刘雅婷¹, 徐春好³, 杨瑞香⁴

¹ 福建医科大学附属第二医院肝胆胰外科泉州市 362000
² 福建医科大学附属第二医院护理部泉州市 362000
³ 福建医科大学附属第二医院胃肠外科泉州市 362000
⁴ 福建医科大学附属第二医院胸外科泉州市 362000

收稿日期:2026-03-18 出版日期:2026-10-20 发布日期:2026-10-12
*通讯作者: 郑美花，女，硕士，副主任护师，E-mail：1625361942@qq.com
作者简介:第一联系人：作者贡献声明
郑美花：研究设计、论文撰写与修改、经费支持；朱芮：数据采集与分析；谢宝缘：项目指导；陈飞燕、黄桂云、王璐祯、刘雅婷：实施研究；徐春好、杨瑞香：技术支持、协助方案落地
基金资助:
福建省泉州市科技计划项目(2023N053S)

Evidence-based practice for enteral nutrition-related abdominal distension and diarrhea in postoperative digestive system tumor patients

ZHENG Meihua¹^,^*(), ZHU Rui¹, XIE Baoyuan², CHEN Feiyan¹, HUANG Guiyun¹, WANG Luzhen¹, LIU Yating¹, XU Chunhao³, YANG Ruixiang⁴

¹ Department of Hepatobiliary and Pancreatic Surgery， the Second Affiliated Hospital of Fujian Medical University， Quanzhou 362000， China
² Department of Nursing， the Second Affiliated Hospital of Fujian Medical University， Quanzhou 362000， China
³ Department of Gastrointestinal Surgery， the Second Affiliated Hospital of Fujian Medical University， Quanzhou 362000， China
⁴ Department of Thoracic Surgery， the Second Affiliated Hospital of Fujian Medical University， Quanzhou 362000， China

Received:2026-03-18 Online:2026-10-20 Published:2026-10-12
* Corresponding author: ZHENG Meihua，E-mail：1625361942@qq.com
Funding program:
Science and Technology Planning Project of Quanzhou，Fujian Province(2023N053S)

摘要/Abstract

摘要：

目的构建消化系统肿瘤患者术后肠内营养相关性腹胀腹泻预防的循证实践方案，并评价其临床应用效果。方法系统检索并评价术后肠内营养相关性腹胀腹泻预防与管理的最佳证据，结合临床情境制订循证实践方案。于2024年7月—2025年2月在福建省某三级甲等医院胃肠外科、胸外科及肝胆胰外科开展研究，基线审查组为2024年6月1日—9月30日入院的59例患者，循证实践组为2024年10月1日—2025年2月28日入院的59例患者。比较方案实施前后患者腹胀腹泻发生率、医护人员审查指标执行率与知识合格率的差异。结果共纳入15条最佳证据，据此制订18项审查指标。两组术后肠内营养相关性腹胀发生率分别为32.20%（19/59）、11.86%（7/59），差异具有统计学意义（χ²=7.104，P=0.008）。两组医护人员在营养风险筛查、腹泻腹胀评估、阶梯式输注、添加乳酸菌、间歇推注、咀嚼口香糖及促动力药使用等9项审查指标的执行率，差异均具有统计学意义（P<0.05）。两组医护人员理论考核合格率分别为67.00%、92.70%，差异具有统计学意义（P<0.001）。结论实施该研究构建的循证实践方案可有效提升医护人员循证实践依从性与专业知识水平，降低消化系统肿瘤患者术后肠内营养相关性腹胀发生率。

关键词: 消化系统肿瘤, 肠内营养, 腹胀, 腹泻, 循证护理学

Abstract:

Objective To develop an evidence-based practice protocol for enteral nutrition-related abdominal distension and diarrhea in postoperative patients with digestive system tumors，and to evaluate its application effect on clinical nursing. Methods The best evidence on the prevention and management of enteral nutrition-related abdominal distension and diarrhea in postoperative patients with digestive system neoplasms was systematically searched and critically appraised. A protocol was developed by integrating the synthesized evidence with clinical context. The study was conducted from July 2024 to February 2025 in the gastrointestinal surgery，thoracic surgery，and hepatobiliary and pancreatic surgery departments of a tertiary grade A hospital in Fujian Province. The baseline group comprised 59 patients admitted between June 1 and September 30，2024，while the evidence-based group comprised 59 patients admitted between October 1，2024 and February 28，2025. Differences in the incidence of abdominal distension and diarrhea in patients，the compliance rate of review indicators，and the pass rate of knowledge assessment among medical staff were compared before and after protocol implementation. Results A total of 15 pieces of best evidence were included，based on which 18 audit indicators were developed. After evidence-based practice，the incidence of postoperative enteral nutrition-related abdominal distension decreased from 32.20% to 11.86%（P=0.008）. The compliance of healthcare professionals with 9 audit indicators was significantly improved（P<0.05），including nutritional risk screening，diarrhea/abdominal distension assessment，stepwise rate advancement，probiotic supplementation，intermittent bolus feeding，gum chewing，and prokinetic agent use. The knowledge qualification rate increased from 67.00% to 92.70%，with a statistically significant difference（P<0.001）. Conclusion The evidence-based protocol can effectively improve medical staff compliance and knowledge，and significantly reduce the incidence of enteral nutrition-related abdominal distension in postoperative patients with digestive system tumors.

Key words: Digestive System Neoplasms, Enteral Nutrition, Abdominal Distension, Diarrhea, Evidence-Based Nursing

郑美花, 朱芮, 谢宝缘, 陈飞燕, 黄桂云, 王璐祯, 刘雅婷, 徐春好, 杨瑞香. 消化系统肿瘤患者术后肠内营养相关性腹胀腹泻预防的循证实践[J]. 中华护理杂志, 2026, 61(20): 2787-2794.

ZHENG Meihua, ZHU Rui, XIE Baoyuan, CHEN Feiyan, HUANG Guiyun, WANG Luzhen, LIU Yating, XU Chunhao, YANG Ruixiang. Evidence-based practice for enteral nutrition-related abdominal distension and diarrhea in postoperative digestive system tumor patients[J]. Chinese Journal of Nursing, 2026, 61(20): 2787-2794.

图/表 3

表1 消化系统肿瘤患者术后肠内营养相关性腹胀腹泻预防与管理的证据内容及审查指标

Table 1 Evidence contents and review indicators for the prevention and management of enteral nutrition-related abdominal distension and diarrhea in postoperative patients with digestive system tumors

表2 循证实践方案的障碍因素、促进因素及行动策略

Table 2 Barriers， facilitators and action strategies of the evidence-based practice protocol

表3 两组一般资料的比较

Table 3 Comparison of general data between 2 groups of patients

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消化系统肿瘤患者术后肠内营养相关性腹胀腹泻预防的循证实践

Evidence-based practice for enteral nutrition-related abdominal distension and diarrhea in postoperative digestive system tumor patients

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