ISSN 2097-6046（网络）
ISSN 2096-7446（印刷）
CN 10-1655/R
主管：中国科学技术协会
主办：中华护理学会
中华急危重症护理杂志

中华急危重症护理杂志 >

2024 , Vol. 5 >Issue 6: 562 - 569

DOI: https://doi.org/10.3761/j.issn.2096-7446.2024.06.015

证据综合研究

肝移植受者围手术期营养支持的最佳证据总结

  • 李天姿 ,
  • 张慧芳 ,
  • 黄月华 ,
  • 莫红平 ,
  • 蔡敏 ,
  • 邱逸红
展开
  • 510120 广州市 中山大学孙逸仙纪念医院护理部（李天姿,邱逸红）,重症医学科（黄月华,莫红平,蔡敏）; 西安交通大学第一附属医院乳腺外科（张慧芳）
李天姿：女,硕士,护士,E-mail：tianzi610@163.com

收稿日期: 2023-07-06

  网络出版日期: 2024-06-21

收起

Summary of the best evidence of perioperative nutritional support for liver transplant recipients

  • LI Tianzi ,
  • ZHANG Huifang ,
  • HUANG Yuehua ,
  • MO Hongping ,
  • CAI Min ,
  • QIU Yihong
Expand

Received date: 2023-07-06

  Online published: 2024-06-21

Fold

摘要

目的 系统检索肝移植受者围手术期营养管理相关研究,总结最佳证据。方法 按照循证资源“6S”模型自上向下检索BMJ最佳临床实践、UpToDate等源数据库,纳入截至2023年4月内容涉及肝移植受者围手术期营养支持的研究,包括临床决策、证据总结、指南、专家共识、系统评价类型的中英文相关文献,由2名研究者通过文献筛选和质量评价确定最终纳入文献,最后进行证据内容的提取与总结。结果 共纳入文献12篇,包括临床决策1篇、指南4篇、专家共识4篇、Meta分析3篇。汇总了建立多学科团队、营养筛查与评估、术前营养摄入目标和种类、术后营养摄入目标及种类、术后营养摄入开始时间、营养支持方式及要求、定期随访7个主题、30条证据。结论 临床实践中可根据循证医学证据制订肝移植受者围手术期营养支持的相关规范,在实践中根据受者具体情况给予营养支持,保证肝移植受者围手术期营养需求的满足。

关键词： 肝移植; 围手术期; 营养支持; 证据总结; 循证护理学

本文引用格式

李天姿 , 张慧芳 , 黄月华 , 莫红平 , 蔡敏 , 邱逸红 . 肝移植受者围手术期营养支持的最佳证据总结[J]. 中华急危重症护理杂志, 2024 , 5(6) : 562 -569 . DOI: 10.3761/j.issn.2096-7446.2024.06.015

Abstract

Objective To systematically search the related research on perioperative nutrition management of liver transplant recipients and summarize the best evidence. Methods According to the "6S" model of evidence-based resources,BMJ best practice,UpToDate and other source databases were searched from top to bottom,and the research on perioperative nutrition management of liver transplant recipients was included up to April 2023,including Chinese and English related literatures on clinical decision-making,evidence summary,guidelines,expert consensus and systematic reviews. Two researchers conducted independent screening and quality evaluation of the related literatures to include the literature finally,and extracted summarized the evidence. Results A total of 12 literature were included,including 1 clinical decision,4 guidelines,4 expert consensuses and 3 meta-analyses. Thirty pieces of evidence were summarized,which were categorized to seven aspects：establishment of multidisciplinary team,nutrition screening and evaluation,preoperative nutrition intake goals and types,postoperative nutrition intake goals and types,postoperative nutrition intake starting time,nutrition support methods and requirements,and follow-up. Conclusion In clinical practice,the relevant norms of perioperative nutritional support for liver transplant recipients can be formulated according to evidence,and nutritional support can be given according to the specific situation of recipients in practice to ensure that the perioperative nutritional needs of liver transplant recipients can be met.

Key words： Liver Transplantation; Perioperative; Nutrition Support; Evidence Summary; Evidence-Based Nursing

参考文献

[1] Dienstag JL,Cosimi AB.Liver transplantation:a vision realized[J]. N Engl J Med,2012,367(16):1483-1485.
[2] 中国医师协会器官移植医师分会,中华医学会器官移植学分会肝移植学组. 中国肝癌肝移植临床实践指南(2021版)[J]. 实用器官移植电子杂志,2022,10(6):430-432.
Transplant Doctors Branch of Chinese Medical Doctor Asso-ciation,Liver Transplantation Group of Organ Trans-plantation Branch of Chinese Medical Association. Clinical practice guidelines of liver transplantation for liver cancer in China(2021 edition)[J]. Pract J Organ Transplant Electron Version,2022,10(6):430-432.
[3] Ribeiro HS,Coury NC,de Vasconcelos Generoso S,et al. Ener-gy balance and nutrition status:a prospective assessment of patients undergoing liver transplantation[J]. Nut Clin Prac,2020,35(1):126-132.
[4] 董炎,张水军. 肝移植术后肠内营养和肠外营养选择的研究进展[J]. 中华器官移植杂志,2018,39(5):311-314.
Dong Y,Zhang SJ.Liver transplantation postoperative enteral nutrition and parenteral nutrition to choose the research progress of[J]. Chin J Organ Transplant,2018,39(5):311-314.
[5] 陈薇,方赛男,刘建平,等. 国际循证医学证据分级体系的发展与现状[J]. 中国中西医结合杂志,2017,37(12):1413-1419.
Chen W,Fang SN,Liu JP,et al.Development and present situation of evidence grading system in international evidence-based medicine[J]. Chin J Integr Tradit West Med,2017,37(12):1413-1419.
[6] The AGREE Next Steps Consortium. AGREE Ⅱ Instrument[EB/OL].(2017-10)[2021-02-17]. https://www.agreetrust.org/wpcontent/uploads/2017/12/AGREE-Ⅱ-Users-Manual-and-23-itemInstrument-2009-Update-2017.pdf.
[7] Shea BJ,Reeves BC,Wells G,et al.AMSTAR 2:a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions,or both[J]. BMJ,2017,358:j4008.
[8] Aromataris E,Munn Z. Joanna Briggs institute reviewer's ma-nual[EB/OL].(2017-07-15)[2022-02-07]. https://wiki.joanna-briggs.org/display/MANUAL/Joanna+Briggs+Institute+Reviewer%27s+Manual.
[9]（美)桑德拉·L.德尔霍尔特,(美)黛博拉·丹格. 约翰·霍普金斯护理循证实践:模型与指南[M]. 北京:中国经济出版社,2017.
Delholt SL,Denger D.Johns Ho-pkins:evidence-based nursing practice model and guide[M]. Beijing:China economic publish-ing house,2017.
[10] 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.
Wang CQ,Hu Y.JBI evidence pre-classification and evidence recommendation level system(2014 edition)[J]. J Nurses Train,2015,30(11):964-967.
[11] Romanowski SK,Askari R. Overview of perioperative nutritio-nal support[EB/OL].(2021-09-13). https://www.uptodate.cn/con-tents/zh-Hans/overview-of-perioperative-nutrition-support?
[12] European Association for the Study of the Liver. EASL Cli-nical practice guidelines on nutrition in chronic liver disease[J]. J Hepatol,2019,70(1):172-193.
[13] Plauth M,Bernal W,Dasarathy S,et al.ESPEN guideline on clinical nutrition in liver disease[J]. Clin Nutr,2019,38(2):485-521.
[14] Brustia R,Monsel A,Skurzak S,et al.Guidelines for perio-perative care for liver transplantation:enhanced recovery after surgery(ERAS) recommendations[J]. Transplantation,2021,106(3):552-561.
[15] 中华医学会肠外肠内营养学分会. 中国成人患者肠外肠内营养临床应用指南(2023版)[J]. 中华医学杂志,2023,103(13):946-974.
Parenteral and Enteral Nutrition(CSPEN) Branch of Chinese Medical Association. Guideline for clinical application of parenteral and enteral nutrition in adults patients in China（2023 edition)[J]. Natl Med J China,2023,103(13):946-974.
[16] 中华医学会器官移植学分会围手术期管理学组. 肝移植围手术期营养支持专家共识(2021版)[J]. 中华器官移植杂志,2021,42(7):385-391.
Perioperative Management Group of Organ Transplantation Branch of Chinese Medical Association. Expert consensus on perioperative nutritional support for liver transplantation（2021)[J]. Chin J Organ Transplant,2021,42(7):385-391.
[17] 中国医师协会器官移植医师分会移植免疫学专业委员会,中国研究型医院学会加速康复外科委员会肝移植加速康复学组. 成人慢加急性肝衰竭肝移植围手术期管理专家共识[J]. 器官移植,2020,11(5):533-542.
Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Asso-ciation,Enhanced Recovery of Liver Transplantation Group of Enhanced Recovery After Surgery Committee of Chinese Re-search Hospital Association. Expert consensus on perioperative management of liver transplantation in adults with acute-on-chronic liver failure[J]. Organ Transplant,2020,11(5):533-542.
[18] 中华医学会器官移植学分会. 中国肝移植受者选择与术前评估技术规范(2019版)[J]. 临床肝胆病杂志,2020,36(1):40-43.
Organ Transplantation Branch of Chinese Medical Associa-tion. Technical specifications for selection and preoperative evalua-tion of liver transplantation recipients in China(version 2019)[J]. J Clin Hepatol,2020,36(1):40-43.
[19] 国家卫生计生委医管中心加速康复外科专家委员会. 中国肝移植围手术期加速康复管理专家共识(2018版)[J]. 中华普通外科杂志,2018,33(3):268-272.
Enhanced Recovery After Surgery Expert Committee of the National Hospital Management Center of Health and Family Planning Commission. Expert consensus on management of accelerated rehabilitation in perioperative period of liver transplantation in China(2018 edition)[J]. Chin J Gen Surg,2018,33(3):268-272.
[20] Li YR,Wei Y,Li J,et al.The clinical effect of early enteral nutrition in liver-transplanted patients:a systematic review and meta-analysis[J]. Clin Res Hepatol Gastroenterol,2021, 45(3):101594.
[21] 朱涵菁,黄明珠,潘宸,等. 肠内营养和肠外营养支持对肝移植术后受者治疗效果的荟萃分析[J]. 中华器官移植杂志,2022, 43(7):418-426.
Zhu HJ,Huang MZ,Pan C,et al.A systematic review of enteral nutrition versus parenteral nutrition on patient out-comes after liver transplantation[J]. Chin J Organ Transplant,2022,43(7):418-426.
[22] 鲁华鹏,肖奇贵,王婧,等. 肝移植术后鼻胃(肠)置管与经皮内镜下胃空肠造瘘置管肠内营养效果的Meta分析[J]. 中华肝胆外科杂志,2018,24(11):751-756.
Lu HP,Xiao QG,Wang J,et al.Effect of enteral nutrition via a naso-gastric(intestinal) tube vs a percutaneous endoscopic gastrostomy/jejunostomy tube in patients after liver transplan-tation:a Meta analysis[J]. Chin J Hepatobiliary Surg,2018,24(11):751-756.
[23] Borhofen SM,Gerner C,Lehmann J,et al.The royal free hos-pital-nutritional prioritizing tool is an independent predictor of deterioration of liver function and survival in cirrhosis[J]. Dig Dis Sci,2016,61(6):1735-1743.
[24] Dasarathy S.Cause and management of muscle wasting in chro-nic liver disease[J]. Curr Opin Gastroenterol,2016,32(3):159-165.
[25] Ney M,Abraldes JG,Ma M,et al.Insufficient protein intake is associated with increased mortality in 630 patients with cirrhosis awaiting liver transplantation[J]. Nutr Clin Pract,2015,30(4):530-536.
[26] Cheng PL,Loh EW,Chen JT,et al.Effects of preoperative oral carbohydrate on postoperative discomfort in patients un-dergoing elective surgery:a meta-analysis of randomized con-trolled trials[J]. Langenbecks Arch Surg,2021,406(4):993-1005.
[27] Kaido T,Mori A,Ogura Y,et al.Pre-and perioperative factors affecting infection after living donor liver transplantation[J]. Nutrition,2012,28(11/12):1104-1108.
[28] Zaloga GP.Phytosterols,lipid administration,and liver disease during parenteral nutrition[J]. JPEN J Parenter Enteral Nutr,2015,39(1 Suppl):39S-60S.
[29] Grąt M,Wronka KM,Lewandowski Z,et al. Effects of conti-nuous use of probiotics before liver transplantation:a rando-mized,double-blind,placebo-con-trolled trial[J]. Clin Nutr,2017, 36(6):1530-1539.
[30] Lei QC,Wang XY,Zheng HZ,et al.Peri-operative immunonu-trition in patients undergoing liver transplantation:a meta-analysis of randomized controlled trials[J]. Asia Pac J Clin Nutr,2015,24(4):583-590.
[31] 褚君卿,高春华,俞超,等. 肺移植患者围手术期营养支持的研究进展[J]. 中华急危重症护理杂志,2021,2(4):360-364.
Chu JQ,Gao CH,Yu C,et al.Lung transplantation patients perioperative nutritional support[J]. Chin J Emerg Crit Care Nurs,2021,2(4):360-364.
[32] 黄旭叶,王薇,卢芳燕,等. 肝移植术后患者住院期间血糖管理的最佳证据总结[J]. 中华急危重症护理杂志,2021,2(3):263-268.
Huang XY,Wang W,Lu FY,et al.Summary of the best evidence for blood glucose management in patients after liver transplantation during hospitalization[J]. Chin J Emerg Crit Care Nurs,2021,2(3):263-268.
[33] 刘海潮,张水军,郭文治. 益生菌应用于肝移植术后患者的临床意义[J]. 中国普通外科杂志,2013,22(1):71-74.
Liu HC,Zhang SJ,Guo WZ.Beneficial effects of probiotics regimen in patients after liver transplantation[J]. Chin J Gen Surg,2013,22(1):71-74.
[34] Gao XJ,Liu YX,Zhang L,et al.Effect of early vs late supple-mental parenteral nutrition in patients undergoing abdominal surgery:a randomized clinical trial[J]. JAMA Surg,2022,157(5):384-393.
[35] Mistiaen P,van den Heede K. Nutrition support teams:a sys-tematic review[J]. JPEN J Parenter Enteral Nutr,2020,44(6):1004-1020.
[36] Fatourou EM,Tsochatzis EA.Management of metabolic synd-rome and cardiovascular risk after liver transplantation[J]. Lancet Gastroenterol Hepatol,2019,4(9):731-741.
Options
文章导航

/

〈 〉