- 期刊
以系統性文獻回顧檢視術前機械性腸道準備對結直腸手術病人之臨床效益
Clinical Effectiveness of Preoperative Mechanical Bowel Preparation on Elective Colorectal Surgery Patients-A Systematic Review
摘要
計畫性結直腸手術病人術前機械性腸道準備（Mechanical Bowel Preparation, MBP）仍被視為常規處置，不僅喝瀉劑，亦要執行經肛門之清潔灌腸，造成病人身體不適。國外學者不建議MBP做為結直腸手術前的必要常規，這樣的建議是否適用於本土病人尚無定論。為瞭解術前是否接受MBP對計畫性結直腸手術病人之臨床效益。全面文獻搜尋共有20篇相關之隨機控制型研究（RCT），符合條件有4篇RCT研究，經過文獻品質評析後，使用RevMan 5.0軟體進行4篇文獻之綜合分析（Meta-analysis），勝算比1.74，95％信賴區間為1.18-2.56，然Cochrane之綜合分析結果顯示術前是否接受MBP對病人手術部位感染率無顯著差異。此實證資料可以提供醫護團隊臨床照護決策的參考，考慮MBP的利益與風險，納入病人的感受，做出最適當的醫護處置，簡化繁瑣的處置流程，以提昇照護品質。
並列摘要
Preoperative mechanical bowel preparation is still regarded as a routine procedure before an elective colorectal surgery. It includes not only taking certain laxatives in solution form, but also performing a cleansing enema, which causes suffering to the patients and their family. This also increases the burden to the nurses' already busy work load and having to repeatedly observe the content and color of the fecal material. Since 1992, many randomized controlled trials show that by not performing preoperative mechanical bowel preparation, it does not increase surgery-related complications, including leakage of the intestinal anastomosis, intra-abdominal abscess formation, or wound infection. By searching the best evidence in the literature and using critical appraisal, the authors tried to find the best decision-making process; through the use of database from hospital records, efforts were made to understand the clinical orders for intestinal preparation before colorectal surgeries and, through nursing records, more was learned about the distressing symptoms of patients' enema. Expectively, by application of international standards, empirical verification of evidence information, and constant communication and cooperation within the medical team, we are able to provide more sophisticated quality of service for the benefit of patients, their families and clinical staff in order to achieve a win-win outcome.