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

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