食管癌患者术后家庭肠内营养管理的最佳证据总结

Summary of the best evidence for postoperative home enteral nutrition management in postoperative patients with esophageal cancer

目的检索食管癌术后患者家庭肠内营养(home enteral nutrition,HEN)管理的相关证据进行评价并整合,为临床制定HEN管理提供循证证据。方法检索UpToDate、澳大利亚循证护理和保健研究中心(Joanna Briggs Institute,JBI)、苏格兰院际间指南网、医脉通、欧洲临床营养与代谢学会网站、Cochrane Library、PubMed、知网、万方等数据库中关于食管癌术后HEN管理的指南、专家共识、系统评价、证据总结、随机对照试验、最佳实践,检索时限为建库至2023年7月31日,由2名研究者独立完成文献质量的评价、证据提取及整合。结果共纳入13篇文献,包括6篇指南,2篇专家共识,2篇系统评价,3篇随机对照研究。共总结出24条最佳证据,包括组建家庭营养支持团队、营养筛查与评估、制定HEN治疗方案、健康宣教、监测评价及随访5个方面。结论本研究总结了食管癌术后患者HEN管理的相关证据,可为临床食管癌术后患者HEN管理提供借鉴和参考,建议结合具体临床情境及利益相关者的意愿有针对性地选择应用证据。

Objective To evaluate and integrate the related evidence of management of home enteral nutrition(HEN)for postoperative patients with esophageal cancer,so as to provide evidence-based recommendations for clinical implementation of home enteral nutrition management.Methods The guidelines,expert consensus,systematic evaluation,evidence summary,randomized controlled trials,and the best practices related to family enteral nutrition management after esophageal cancer surgery were searched in databases such as UpToDate,Joanna Briggs Institute(JBI)Evidence Based Health Care Center in Australia,Scottish Interhospital Guidelines Network,Yimaitong,European Society for Clinical Nutrition and Metabolism website,Cochrane Library,PubMed,CNKI,Wanfang,etc,and the retrieval time limited from database establishment to July 2023,and the evaluation of literature quality,evidence extraction,and aggregation independently were completed by 2 researchers.Results A total of 13 articles were included,including 6 guidelines,2 expert consensus,2 systematic evaluations,and 3 randomized controlled studies.A total of 24 best pieces of evidence had been summarized,including 5 aspects:Establishing a family nutrition support team,nutrition screening and evaluation,developing HEN treatment plans,health education,monitoring evaluation,and follow-up.Conclusion The relevant evidences for HEN management in postoperative patients with esophageal cancer are summarized in this study,which can provide example and reference for HEN management in clinical esophageal cancer patients after surgery.It is recommended to combine specific clinical scenarios and the wishes of stakeholders with targeted application evidence.