胃肠道手术患者围手术期禁食禁饮管理循证证据总结

Summary on the Evidence-based Clinical Practice for Perioperative Fasting Management in Gastrointestinal Surgery

目的总结胃肠道手术患者围手术期禁食禁饮管理的循证证据意见。方法计算机检索Cochrane Library、JBI、安大略注册护士协会、美国指南网、循证医学数据库、PubMed、荷兰医学文摘数据库、中国生物医学文献数据库,查找胃肠道手术患者围手术期禁食禁饮的相关指南。经2名研究人员独立进行文献质量评价和资料提取,对符合纳入标准的指南进行证据总结。结果共纳入指南7篇,专家共识2篇,最终总结出4条最佳证据,分别为:(1)缩短术前禁食时间,固体食物术前6 h禁食,清流质术前2 h禁食(A级推荐);(2)术前口服碳水化合物,但糖尿病患者慎用(B级推荐);(3)术后尽早经口进食,同时注意恶心、呕吐等不良反应(A级推荐);(4)采用多种方式提供营养支持,促进肠道功能恢复(B级推荐)。结论临床上应结合胃肠道手术患者具体情况,合理根据循证医学证据进行临床实践。

Objective To summarize the evidence-based clinical practice of perioperative fasting management in gastrointestinal surgery.Methods Guidelines about perioperative fasting in gastrointestinal surgery were retrieved in Cochrane Library,JBI,Ontario Registered Nurses Association,American Guide Network,Evidence-Based Medicine Database,Pub Med,Dutch Medical Abstracts Database and China Biomedical Literature Database and given evidencebased evaluations and data extraction by 2 researchers;the evidence-based clinical practice was summarized from the guidelines that met the criteria.Results 7 guidelines and 2 expert consensus were included,from which 4 best evidences were summarized:(1)shortening preoperative fasting duration,fasting solid food 6 hours before surgery and fasting clear liquids 2 hours before surgery(Grade-A recommendation);(2)preoperative oral carbohydrates administration(not recommended in cases with diabetes,Grade-B recommendation);(3)resuming oral intake as early as possible after surgery,while being alert to adverse reactions such as nausea and vomit(Grade-A recommendation);(4)providing various nutritional support to promote intestinal function recovery(Grade-B recommendation).Conclusions Based on individual condition,clinical practice on cases of gastrointestinal surgery should be supported by evidence-based medicine.