Abstract:

Objective To retrieve the best evidence on early enteral nutrition in patients after pancreaticoduodenectomy（PD）and to summarize the best available evidence for clinical nurses to provide evidence-based guidance for the management. Methods All evidence on early enteral nutrition in patients after PD was retrieved from databases and websites including UpToDate,BMJ Best Practice,JBI Library,Cochrane Library,NICE,ASPEN,ESPEN,PubMed,CBM,VIP,CNKI and Wanfang. The retrieved evidence included guidelines,expert consensuses,evidence summaries,systematic reviews,meta-analysis and related original studies. The retrieval period was from the inception of databases to June 15,2020. 2 researchers with evidence-based nursing background assessed the quality of the literature independently,combined with the opinions of professionals,extracted and summarized the evidence of the literature that met the quality standards. Results A total of 281 references were obtained from the initial search,and 12 pieces of literature were included,including 4 guidelines,1 expert consensus,2 systematic evaluations and 5 meta-analysis. Finally,totally 11 pieces of best evidence were summarized from 4 aspects on indications and safety assessment of early enteral nutrition,timing of early enteral nutrition,route selection and target nutrient requirement management. Conclusion Early enteral nutrition after PD is safe and feasible. Evidence users should select best evidence based on the clinical context,the promoting factors and the obstacles and willingness of patients,so as to form a scientific and evidence-based practice plan for early enteral nutrition after PD management,and to accelerate patients’ recovery and improve nursing quality.

Key words: Pancreatoduodenectomy, Enteral Nutrition, Rehabilitation Nursing, Evidence-Based Nursing

摘要：

目的 检索胰十二指肠切除术后患者早期肠内营养的相关证据,并对最佳证据进行总结,为临床护士实施胰十二指肠切除术后早期肠内营养管理提供循证依据。 方法 计算机检索UpToDate、BMJ Best Practice、乔安娜布里格斯研究所循证卫生保健国际合作中心图书馆、Cochrane Library、英国国家临床优化研究所、美国肠外肠内营养学会、欧洲临床营养与代谢学会、PubMed、中国生物医学文献数据库、维普、中国知网和万方数据库中关于胰十二指肠切除术后患者早期肠内营养的所有证据,包括指南、专家共识、系统评价、Meta分析。检索时限为建库至2020年6月15日。由2名经过循证培训的研究者独立完成文献的质量评价,并结合专业人士的意见,对符合质量标准的文献进行证据提取及总结。 结果 初步检索共获得文献281篇,最终纳入12篇文献,包括4篇指南、1篇专家共识、2篇系统评价、5篇Meta分析,从早期肠内营养适应证及安全性评估、开展早期肠内营养的时机、途径的选择以及目标营养需要量管理4个方面汇总11条最佳证据。 结论 胰十二指肠切除术后患者早期进行肠内营养安全可行。在实施早期肠内营养的管理中,护理人员应结合临床情境、医护人员应用证据的促进因素及阻碍因素、患者意愿选择最佳证据,以形成科学、有循证依据的胰十二指肠切除术后早期肠内营养管理方案,从而加速患者康复,提升护理质量。

关键词: 胰十二指肠切除术, 肠道营养, 康复护理, 循证护理学