以质量求发展，以服务铸品牌

护理学报 ›› 2022, Vol. 29 ›› Issue (4): 27-33.doi: 10.16460/j.issn1008-9969.2022.04.027

• 循证护理 • 上一篇    下一篇

成人炎症性肠病患者饮食与营养方案的循证实践

林俏1a,2, 刘梅娟1a, 张广清1b, 赵芯梅1a, 夏燕飞1a, 施燕1a, 曾依婷1a, 赖女珍1a, 周丽华1a, 李秀梅1a   

  1. 1.南方医科大学南方医院 a.消化内科;b.医院办公室,广东 广州 510515;
    2.南方医科大学 护理学院,广东 广州 510515
  • 收稿日期:2021-09-30 出版日期:2022-02-25 发布日期:2022-03-04
  • 通讯作者: 张广清（1966-）,女,湖南湘潭人,本科学历,硕士研究生导师,主任护师。 E-mail:hlbzhang@sina.com
  • 作者简介:林俏（1987-）,女,山东新泰人,本科学历,硕士研究生在读,主管护师。
  • 基金资助:
    广东省自然科学基金（2019A1515010987）; 南方医院护理创优-循征护理项目（2020EBNb013）

Evidence-based Practice of Diet and Nutrition Programs for Adults with Inflammatory Bowel Disease

LIN Qiao1a,2, LIU Mei-juan1a, ZHANG Guang-qing1b, ZHAO Xin-mei1a, XIA Yan-fei1a, SHI Yan1a, ZENG Yi-ting1a, LAI Nv-zhen1a, ZHOU Li-hua1a, LI Xiu-mei1a   

  1. 1a Dept. of Gastroenterology; 1b. Headquarter Office, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China;
    2. School of Nursing, Southern Medical University, Guangzhou 510515, China
  • Received:2021-09-30 Online:2022-02-25 Published:2022-03-04

赞

摘要： 目的 将成人炎症性肠病患者饮食与营养方案的最佳证据应用于临床,并评价其效果。方法 本研究依据上海复旦的基于证据的持续质量改进模式图为指导方法,将最佳证据结合研究者所在临床环境,转化成相应的审查指标及审查方法,进行现状审查,分析实施过程中存在的问题及原因并制订解决方法。比较证据实施前后护理人员对成人炎症性肠病饮食与营养的知晓情况及对审查指标的执行情况。结果 证据实施前后,临床护士对炎症性肠病饮食与营养的相关知识得分分别为 15~34（25.00±6.14）分和30~36（34.61±1.98）分,差异具有统计学意义（t=6.326,P<0.001）。证据应用后有4项审查指标执行情况优于证据应用前（P<0.05）。结论 通过制定和应用成人炎症性肠病饮食与营养的最佳证据并将适宜临床情境的证据进行转化并应用,可规范护士依据证据执行的行为,促进护理持续质量改进。

关键词: 炎症性肠病, 饮食, 营养, 循证实践

Abstract: Objective To To apply the best evidence for diet and nutrition programs for adults with inflammatory bowel disease and to evaluate its clinical effects. Methods This study was guided by the evidence-based continuous quality improvement model. Combined with the clinical scenario, the best evidence was transformed into the corresponding review indicators and review methods. Solutions were formulated after the review of current situation, and the analysis of the problems and causes existing in the implementation process. Awareness of nurses towards diet and nutrition for adults with inflammatory bowel disease and implementation of audit indicators among nurses were compared before and after the application. Results Before and after the application of the evidence, clinical nurses' score of knowledge on diet and nutrition for adults with inflammatory bowel disease was 15~34（25.00±6.14）and 30~36（34.61±1.98） respectively,and the difference was statistically significant（t=6.326,P<0.001）. After the application of evidence,implementation rate of 4 audit indicators was improved （P<0.05）. Conclusion Evidence-based practice of diet and nutrition programs for adults with inflammatory bowel disease can regulate the behaviors of nurses, improve nurses' compliance, and quality of clinical nursing.

Key words: inflammatory bowel disease, diet, nutrition, evidence-based nursing

中图分类号: 

  • R473.57
[1] 中国炎症性肠病营养诊疗共识[J].中国炎症性肠病营养诊疗共识[J]. 中华消化病与影像杂志(电子版),2021,11(1):8-15.DOI:10.3877/cma.j.issn.2095-2015.2021.01.002.
[2] 王俊珊,赵玉洁,郭传勇,等.炎症性肠病并发营养不良的肠内营养治疗新进展[J].世界临床药物,2019,40(5):320-323. DOI:10.13683/j.wph.2019.05.005.
[3] 周英凤,胡雁,顾莺,等.基于证据的持续质量改进模式图的构建[J].中国循证医学杂志,2017,17(5):603-606. DOI:10.7507/1672-2531.201611090.
[4] Brouwers MC, Kho ME,Browman GP,et al.AGREE II: Advancing Guideline Development, Reporting and Evaluation in Health Care[J]. CMAJ,2010,182(18): E839-E842. DOI:10.1503/cmaj.090449.
[5] The Joanna Briggs Institute. Critical Appraisal Checklist for Text and Opinion[EB/OL]. [2020-11-01]. http://joannabriggs.org/research/critical-appraisal-tools.html.
[6] Cabre E, Manosa M, Gassull MA.Omega-3 Fatty Acids and Inflammatory Bowel Diseases-a Systematic Review[J]. Br J Nutr, 2012, 107(Suppl 2):S240-52.
[7] Lev-Tzion R, Griffiths AM, Leder O, et al. Omega 3 Fatty Acids (Fish Oil) for Maintenance of Remission in Crohn's Disease[J]. Cochrane Database Syst Rev,2014,2:CD006320.
[8] 顾莺,张慧文,周英凤,等. JBI循证卫生保健中心关于不同类型研究的质量评价工具-系统评价的方法学质量评价[J].护士进修杂志,2018,33(8):701-703.DOI:10.16821/j.cnki.hsjx.2018.08.008.
[9] Delegge MH. Nutrition and Dietary Management for Adults with Inflammatory Bowel Disease[EB/OL].(2020-04-17)[2020-11-01].https://www.uptodate.cn/contents/zh-Hans/nutrition-and-dietary-management-for-adults-with-inflammatory-bowel-disease?search=%E7%82%8E%E7%97%87%E6%80%A7%E8%82%A0%E7%97%85%E9%A5%AE%E9%A3%9F&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.
[10] Teitebaum JE. Vitamin and Mineral Deficiencies in Inflammatory Bowel Disease[EB/OL].(2019-03-28)[2020-11-01].https://www.uptodate.cn/contents/zh-Hans/vitamin-and-mineral-deficiencies-in-inflammatory-bowel-disease?search=%E7%82%8E%E7%97%87%E6%80%A7%E8%82%A0%E7%97%85%E9%A5%AE%E9%A3%9F&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3.
[11] Bischoff SC, Escher J, Hébuterne X,et al.ESPEN Practical Guideline: Clinical Nutrition in Inflammatory Bowel Disease[J]. Clin Nutr, 2020, 39(3):632-653. DOI:10.1016/j.clnu.2019.11.002.
[12] Lamb CA, Kennedy NA, Raine T,et al.British Society of Gastroenterology Consensus Guidelines on the Management of Inflammatory Bowel Disease in Adults[J]. Gut, 2019, 68(Suppl 3):s1-s106. DOI:10.1136/gutjnl-2019-318484.
[13] Lee J, Allen R, Ashley S, et al.British Dietetic Association Evidence-Based Guidelines for the Dietary Management of Crohn's Disease in Adults[J]. J Hum Nutr Diet, 2014, 27(3):207-218. DOI:10.1111/jhn.12176.
[14] Matsuoka K, Kobayashi T, Ueno F, et al.Evidence-Based Clinical Practice Guidelines for Inflammatory Bowel Disease[J]. J Gastroenterol, 2018, 53(3):305-353. DOI:10.1007/s00535-018-1439-1.
[15] Gomollón F, Dignass A, Annese V, et al.3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management[J]. J Crohns Colitis, 2017, 11(1):3-25. DOI:10.1093/ecco-jcc/jjw168.
[16] Kemp K, Dibley L, Chauhan U, et al.Second N-ECCO Consensus Statements on the European Nursing Roles in Caring for Patients with Crohn's Disease or Ulcerative Colitis[J]. J Crohns Colitis, 2018,12(7):760-776.DOI:10.1093/ecco-jcc/jjy020.
[17] Levine A, Rhodes JM, Lindsay JO, et al.Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases[J]. Clin Gastroenterol Hepatol, 2020, 18(6):1381-1392. DOI:10.1016/j.cgh.2020.01.046.
[18] 中华医学会消化病学分会炎症性肠病学组.炎症性肠病营养支持治疗专家共识(第2版)[J]. 中华炎性肠病杂志, 2018,2(3):154-172.DOI:10.3760/cma.j.issn.2096-367X.2018.03.004.
[19] The Joanna Briggs Institute(JBI). Inflammatory Bowel Disease (IBD):Fish Oil (Omega-3 Fatty Acids) [EB/OL].(2021-06-09)[2021-07-01].https://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi?&S=HFMBFPFCFMEBNOCMJPNJLGIHFPGJAA00&Link+Set=S.sh.18%7c1%7csl_190
[20] 王春青,胡雁.JBI证据预分级及证据推荐级别系统 (2014版)[J]. 护士进修杂志,2015,30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[21] 温彩霞,徐玲芬,吴巍,等.成年人克罗恩病患者饮食方案的构建[J].中国实用护理杂志,2019,35(8):593-599. DOI:10.3760/cma.j.issn.1672-7088.2019.08.007.
[22] 张献娜,蒋朱明,康维明,等. 营养风险筛查和全球(营养)领导人发起的营养不良诊断(GLIM)第二、三步流程(共识 2020)[J].中华临床营养杂志,2020,28(4):193-200. DOI:10.3760/cma.j.cn115822-20200824-00199.
[23] 石汉平,丛明华,陈伟. 再论营养不良的三级诊断[J]. 中国医学前沿杂志(电子版),2020,12(1):1-7.DOI:10.12037/YXQY.2020.01-01.
[24] 王晴文,朱爱芳,郭兵妹,等.炎症性肠病患者营养护理质量评价指标的构建[J].中华护理杂志,2020,55(3):410-415.DOI:10.376l/j.issn.0254-1769.2020.03.019.
[25] 詹昱新,杨中善,李素云,等.基于循证构建住院患者肠内营养护理质量评价指标体系[J].护理学报,2019,26(10):26-31.DOI:10.16460/j.issn1008-9969.2019.10.026.
[26] 黎晓艳,童莺歌,张月. 循证护理实践影响因素的研究进展[J].护理学报,2017,24(3):35-39.DOI:10.16460/j.issn1008-9969.2017.03.035.
[1] 郭林芳, 张培莉, 侯晓雅, 李滢, 曹敏, 高超越. 肝癌化疗患者线上线下结合营养干预方案的构建[J]. 护理学报, 2025, 32(4): 1-5.
[2] 杨小娟, 毛孝容, 王静, 江华, 李蓉, 樊宇, 文青, 李林章, 陈晓容. 成人重度烧伤患者早期肠内营养管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 56-61.
[3] 曹敏, 张培莉, 侯晓雅, 高超越, 郭林芳, 李滢. ABC-X模型下结直肠癌化疗患者照顾者营养照护体验的质性研究[J]. 护理学报, 2025, 32(2): 13-18.
[4] 夏碧芸, 陈瑜, 吴彦妍, 胡雁. 降低经桡动脉冠状动脉介入术后老年患者桡动脉闭塞发生的循证实践[J]. 护理学报, 2025, 32(2): 37-43.
[5] 孙素亚, 陈亚梅, 陈伟仙, 薄瑾, 刘晓红, 黄燕, 林梦月. 认知性访谈在过渡期炎症性肠病患者过渡准备量表文化调适中的应用[J]. 护理学报, 2024, 31(6): 1-5.
[6] 林育鹏, 张丽. 231例炎症性肠病复发患者挫败感现状及影响因素分析[J]. 护理学报, 2024, 31(6): 18-21.
[7] 李春萍, 张兰萍, 王晓辉, 钟乐欣, 杨薇, 赵青, 吕森森, 李嘉琪, 谢昀筠, 黄婉晴, 陈晓珊, 徐东. 实施理论—常态化过程理论的解读[J]. 护理学报, 2024, 31(5): 39-43.
[8] 江艳, 唐文娟, 赵海燕, 范巧玲. 新生儿营养风险筛查工具的研究进展[J]. 护理学报, 2024, 31(22): 26-29.
[9] 李嘉琪, 叶向红, 左俊焘, 徐瑶, 姚红林. 终末期患者营养支持决策过程质性研究的Meta整合[J]. 护理学报, 2024, 31(2): 53-58.
[10] 张丽, 李付华, 古小改, 郝娜, 王丹丹, 关美琪. 炎症性肠病专科护士培训方案的构建[J]. 护理学报, 2024, 31(19): 31-36.
[11] 武洁, 张培莉, 侯晓雅, 高超越, 刘雨溦, 张玉颖. 同伴支持在肿瘤患者营养管理中的研究进展[J]. 护理学报, 2024, 31(18): 30-34.
[12] 张淑珍, 余文汝, 张俊峰, 江佳瑶, 罗美, 林碧玉, 麦敏雯, 杨梦婷. 肿瘤放疗患者放射性皮炎预防与管理的循证护理实践[J]. 护理学报, 2024, 31(16): 62-66.
[13] 单淑慧, 胡静, 刘佳, 许佳琪, 罗永梅, 王志稳. 成人造血干细胞移植患者饮食管理最佳证据总结[J]. 护理学报, 2024, 31(16): 67-73.
[14] 刘瑶, 詹欣, 谢亭平, 陈炜, 胡依阳, 杨翠娜, 张国忠. 脑血管造影术后使用股动脉压迫止血器患者早期活动的循证实践[J]. 护理学报, 2024, 31(15): 29-33.
[15] 黄润, 张海波, 刘萍. 基于血糖优化的早期间断肠内营养在心脏瓣膜置换术后应激性高血糖患者中的应用[J]. 护理学报, 2024, 31(15): 68-72.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!