Ng Wai Quin, Neill Jane
Alexandra Hospital, Singapore.
J Clin Nurs. 2006 Jun;15(6):696-709. doi: 10.1111/j.1365-2702.2006.01389.x.
To review research on early oral feeding following elective, open colorectal surgery.
Fasting following gastrointestinal surgery is a traditional surgical practice, based on fears of causing postoperative complications if oral intake begins before bowel function returns, but fasting following elective surgery is questionable as a best practice.
Searches in Journals@Ovid CINAHL, MEDLINE, PubMed, Web of Science and The Cochrane Library for primary studies, published during 1995-2004, used the keywords: 'surgery', 'postoperative', 'elective, 'colorectal', 'bowel, 'colon', 'oral', 'enteral', 'feeding', 'early', 'traditional'. Studies of adults undergoing elective, open colorectal surgery who were allowed fluids and food before bowel function returned (early feeding) were included. Outcomes of interest were safety, tolerability, duration of gastrointestinal ileus and length of hospital stay. Critical appraisal of randomized and controlled studies was undertaken following inclusion.
Fifteen studies comprising 1352 patients were reviewed. All studies concluded early feeding was safe, based on complications rates. Total complications were 12.5% (range 0-25%) for 935 early feeding patients, with no increased risk of anastomotic leak, aspiration pneumonia, or bowel obstruction. For all studies an average of 86% patients (range 73-100%) tolerated early feeding. Studies demonstrating faster resolution of postoperative ileus or shorter hospitalization were associated with multimodal perioperative care, including early mobilization, epidural analgesia and comprehensive patient education. Appraisal of five randomized trials revealed no blinding and inadequate randomization.
This review supports early oral feeding after elective, open colorectal surgery and challenges the traditional practice of fasting patients until return of bowel function. Early feeding was safe, well-tolerated and easy to implement. Reduced length of ileus and shorter hospitalization may occur with multimodal protocols.
Nurses can highlight this new evidence for other health professionals, advocate development of clinical protocols featuring early feeding and participate in multi-disciplinary, multi-method research regarding benefits of early feeding.
回顾择期开放性结直肠手术后早期经口进食的相关研究。
胃肠道手术后禁食是一种传统的外科做法，原因是担心在肠道功能恢复前开始经口摄入会导致术后并发症，但择期手术后禁食作为最佳做法存在疑问。
在Journals@Ovid CINAHL、MEDLINE、PubMed、Web of Science和Cochrane图书馆中检索1995年至2004年期间发表的主要研究，使用关键词：“手术”、“术后”、“择期”、“结直肠”、“肠道”、“结肠”、“经口”、“肠内”、“喂养”、“早期”、“传统”。纳入对接受择期开放性结直肠手术且在肠道功能恢复前允许摄入液体和食物（早期喂养）的成年人的研究。感兴趣的结果包括安全性、耐受性、胃肠道肠梗阻持续时间和住院时间。纳入研究后对随机对照研究进行严格评价。
共回顾了15项研究，涉及1352例患者。所有研究根据并发症发生率得出早期喂养是安全的结论。935例早期喂养患者的总并发症发生率为12.5%（范围为0 - 25%），吻合口漏、吸入性肺炎或肠梗阻风险未增加。所有研究中平均86%的患者（范围为73 - 100%）耐受早期喂养。显示术后肠梗阻缓解更快或住院时间更短的研究与多模式围手术期护理相关，包括早期活动、硬膜外镇痛和全面的患者教育。对五项随机试验的评价显示存在缺乏盲法和随机化不足的问题。
本综述支持择期开放性结直肠手术后早期经口进食，并对患者肠道功能恢复前禁食的传统做法提出挑战。早期喂养安全、耐受性良好且易于实施。多模式方案可能会缩短肠梗阻持续时间和缩短住院时间。
护士可以向其他医疗专业人员强调这一新证据，倡导制定以早期喂养为特色的临床方案，并参与关于早期喂养益处的多学科、多方法研究。
