目的:检索并整合改善结肠镜检查前肠道准备质量及病人耐受性的最佳证据,为临床实践提供参考.方法:使用PIPOST模式确定问题,按照"6S"证据模型检索国内外结肠镜检查前肠道准备质量及病人耐受性的相关文献,对纳入研究的证据进行质量评价和分级.结果:共纳入文献19篇,包括4篇指南、1篇临床决策、5篇证据总结、4篇系统评价、4篇随机对照试验、1篇文献综述,共总结了23条证据,包括结肠镜检查前肠道准备的指导及宣教、饮食准备、导泻剂的方案选择、用药时机、辅助措施、不良反应的处理6个方面.结论:临床医护人员需结合病人偏好及临床实践选择最佳证据,降低肠道准备不耐受发生率,提高肠道准备质量.

To investigate their compliance with postoperative oral nutritional supplementation and nutritional outcomes.A total of 84 patients with colorectal cancer surgery with NRS-2002 risk score ≥ 3 who were treated with oral nutritional supplementation were selected and divided into control and observation groups according to the random number table method, with 42 cases in each group. The control group received conventional oral nutritional supplementation and dietary nutrition education; the observation group established a nutrition intervention group based on the Goal Attainment Theory and carried out individualized nutrition education based on the Goal Attainment Theory. The nutritional indicators at 1 day postoperative, 7 days postoperative, oral nutritional supplementation adherence scores at 7 and 14 days postoperative, and the attainment rate of trans-oral nutritional intake at 21 days postoperative were compared between the 2 groups of patients.There was no statistically significant difference between the nutritional status indexes of the 2 groups of patients before the intervention, p > 0.05; when comparing the prealbumin of the 2 groups of patients at 7 days postoperatively, the prealbumin level of the patients in the observation group at 7 days postoperatively (200.25 ± 53.25) was better than that of the control group (165.73 ± 43.00), with a p value of 0.002, and the difference was statistically significant (p < 0.05). Comparison of oral nutritional supplementation adherence scores at 7 and 14 days postoperatively showed that ONS treatment adherence scores were better than those of the control group, with statistically significant differences (p < 0.05). When comparing the attainment rate of oral nutritional intake at 21 days after surgery, the difference was statistically significant (p < 0.05).Nutritional education based on the Goal Attainment Theory can effectively improve the adherence to oral nutritional supplementation therapy and protein intake attainment rate of colorectal cancer patients after surgery and effectively improve the nutritional status of patients.

本文总结1例顽固性便秘合并焦虑、抑郁状态患者术后肠内营养不耐受的处理方法.本例患者存在情绪波动、治疗依从性差(不肯治疗、活动)情况,在肠内喂养过程中出现腹胀、呕吐、胃排空障碍等症状,不耐受评分5分.实施情绪管理、改良肠内营养输注方式、胃肠减压、温盐水洗胃、造口护理、腹部按摩、温水足浴等护理方法.经护理,患者情绪逐步稳定,愿意配合药物治疗和活动,依从性提高,消化道症状逐步缓解,肠内喂养量逐渐增加.肠内营养的不耐受与多种因素有关,本例患者存在情绪波动,情绪和胃肠动力通过脑肠轴相互影响,在实施肠内营养过程中情绪管理尤其重要,同时要重视患者腹痛、腹胀症状,改良肠内营养输注方法,用腹部按摩、温水足浴的方法缓解腹胀,增进患者舒适度,指导患者和家属造口的护理方法,增强患者自我效能.

目的 探讨运用思维导图联合快速康复理念制定结直肠患者围手术期阶段性健康教育的流程图,对患者健康知识掌握达标率、健康教育满意度的影响.方法 89例结直肠癌患者按入院先后分为对照组和观察组,对照组45人,观察组44人.对照组进行阶段性常规健康教育;观察组在常规基础上运用健康教育流程图.采用自行制定的结直肠癌患者围手术期知识问卷、健康教育满意度问卷进行调查.结果 观察组的知识掌握得分和满意度得分均高于对照组(P<0.05).结论 利用思维导图联合快速康理念制定流程图进行结直肠患者阶段健康教育,患者围手术期知识掌握达标率和健康教育满意度都有所提高.

痔疮的患病率很高,占肛肠疾病(痔疮、肛瘘、肛周脓肿、直肠息肉等)的87％,女性痔疮的发病率高于男性,孕产妇痔疮的发生率高达76％.得了痔疮如果治疗不当,有可能导致痔疮加重;长期的慢性失血,严重者需要输血治疗.因此积极开展痔疮的防治是十分必要的.