目的 评价基于循证构建的胃癌术后早期经口饮食方案的应用效果。 方法 根据证据金字塔“6S”模型,系统检索国 内外有关胃癌术后早期经口饮食相关的专家共识、系统评价、证据总结、指南等,结合临床实际制订循证护理实践方案。 选取 陆军军医大学大坪医院创伤外科和胃肠外科行胃癌切除手术的患者,其中循证护理实践前的 2020 年 1 月至 2021 年 4 月的 105 例患者为对照组,2021 年 5 月至 2022 年 12 月的 141 例患者为试验组。 试验组进行术后早期经口饮食干预,比较两组患 者术后经口饮食开始时间、吻合口/ 残端瘘发生情况、胃管留置时间、肛门排气排便时间、术后住院天数、住院费用等结局指标。 结果 试验组术后经口饮食开始时间由 6(3,8)d 缩短到 1(1,4)d、胃管留置时间由 5(4,7)d 缩短到 3(0,4. 75) d、肛门排气时间 由 4(4,6)d 缩短到 3(3,4)d、术后排便时间由 5(4,6)d 缩短到 4. 5(3,5)d、术后住院天数由 10(9,12)d 缩短到 8(7,9)d、住院 费用由 7. 44(6. 66,8. 81)万元减少到 5. 86(5. 33,6. 90)万元,差异均具有统计学意义(P<0. 05);术后吻合口/ 残端瘘发生情况 无显著差异(P>0. 05)。 试验组和对照组白细胞计数、中性粒细胞计数、淋巴细胞计数、血红蛋白水平、血清白蛋白水平差异无 统计学意义(P>0. 05)。 结论 基于循证构建的胃癌术后早期经口饮食方案能加速胃癌术后胃肠功能的恢复,同时未增加术后 瘘的发生率;但对住院期间炎症及营养状态没有显著影响。

Objective To evaluate the effect of an evidence - based early postoperative oral feeding protocol for patients after gastrectomy. Method According to the "6S" model of the evidence pyramid we systematically searched for domestic and international expert consensus systematic evaluation evidence summaries and guidelines related to early post - operative oral diet for gastric cancer and then formulated an evidence-based nursing practice plan in combination with clinical reality. Patients who underwent gastric cancer resection surgery in Daping Hospital were selected in which 105 patients from January 2020 to April 2021 before the evidence-based nursing practice were the control group and 141 patients from May 2021 to December 2022 were the evidence-based nursing practice group. The practice group underwent early postoperative transoral dietary intervention and outcome indicators such as postoperative transoral dietary initiation time anastomotic leakage / residual leakage gastric tube retention time anal gas defecation time postoperative hospitalisation days and hospitalisation costs were compared between the two groups. Result In the practice group postoperative transoral diet start time was shortened from 6 3 8 d to 1 1 4 d gastric tube retention time was shortened from 5 4 7 d to 3 0 4. 75 d anal defecation time was shortened from 4 4 6 d to 3 3 4 d postoperative bowel movement time was shortened from 5 4 6 d to 4. 5 3 5 d and postoperative hospitalisation days were shortened from 10 9 12 d to 8 7 9 d and the hospitalisation cost was reduced from ￥ 74 400 66 600 88 100 to ￥ 58 600 53 300 69 000 with the differences being statistically significant P < 0. 05 There was no significant difference in postoperative anastomotic leakage / residual leakage P > 0. 05 . There was no significant difference in leukocyte count neutrophil count lymphocyte count hemoglobin level and serum albumin level between experimental group and control group P>0. 05 . Conclusion An evidence-based early postoperative oral feeding protocol for gastric cancer after surgery can accelerate the recovery of gastrointestinal function without increasing leakage but the impact on inflammation and nutritional status during hospitalization is not significant.