收稿日期: 2024-10-23
网络出版日期: 2025-04-16
Summary of the best evidence for nutritional management in patients with gastrointestinal acute graft-versus-host disease after hematopoietic stem cell transplantation
目的 总结造血干细胞移植并发胃肠道急性移植物抗宿主病（gastrointestinal acute graft-versus-host disea-se，GI-aGVHD）患者营养管理最佳证据。方法 根据“6S”模型，系统检索国内外计算机决策支持系统、指南网、相关专业学会或机构网站、数据库，筛选与造血干细胞移植并发GI-aGVHD患者营养管理相关的文献，包括指南、临床决策、证据总结、专家共识、专家意见、系统评价，检索时限为建库到2024年12月。由研究人员对文献进行筛选、资料提取、质量评价，并对证据进行提取、整合及质量分级。结果 共纳入13篇文献，其中，临床决策3篇、指南3篇、证据总结1篇、专家共识3篇、系统评价3篇。从多学科合作、营养风险筛查及评估、营养素需求、营养支持方式选择、四阶梯口服饮食治疗方案、健康教育、营养监测7个方面共汇总20条最佳证据。结论 该研究总结的最佳证据，可为造血干细胞移植并发GI-aGVHD患者营养管理提供循证依据。医护人员应结合临床实际情境、患者及家属意愿选择并践行最佳证据，从而改善患者的结局。
温燕玲 , 杨静雯 , 王鲁星 , 王婷婷 , 赵妍敏 , 王华芬 . 造血干细胞移植并发胃肠道急性移植物抗宿主病患者营养管理的最佳证据总结[J]. 中华护理教育, 2025 , 22(4) : 494 -501 . DOI: 10.3761/j.issn.1672-9234.2025.04.018
Objective To summarize the best evidence on nutritional management for patients with acute graft-versus-host disease（GVHD） of the gastrointestinal tract after hematopoietic stem cell transplantation（HSCT）.Methods Based on the “6S” model，a systematic search was conducted in domestic and foreign computerized decision support systems，guideline websites，websites of relevant professional societies or institutions，and databases. Relevant literature on nutritional management for patients with acute GVHD of the gastrointestinal tract after HSCT was screened，including guidelines，clinical decisions，evidence summaries，expert consensuses，expert opinions，and systematic reviews. The search period was from the establishment of the database to December 2024. The researchers screened the literature，extracted the data，evaluated the quality of the included literature，and afterward，extracted，integrated，and graded the evidence.Results A total of 13 articles were included，including three clinical decisions，three guidelines，one evidence summary，three expert consensuses，and three systematic reviews. A total of 20 best pieces of evidence were summarized from seven aspects，including multidisciplinary collaboration，nutritional risk screening and assessment，nutrient requirements，selection of nutritional support methods，four-step oral diet treatment plan，health education，and nutritional monitoring.Conclusion The best evidence summarized in this study can provide evidence-based basis for nutrition management in patients with acute GVHD of the gastrointestinal tract after HSCT. Healthcare professionals should select and implement the best evidence in combination with clinical realities and the wishes of patients and their families，thereby improving patient outcomes.
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