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Article(id=1322929611570553799, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929547464815391, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.14.014, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1753977600000, receivedDateStr=2025-08-01, revisedDate=1776614400000, revisedDateStr=2026-04-20, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340598242, onlineDateStr=2026-10-30, pubDate=1784908800000, pubDateStr=2026-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340598242, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340598242, creator=13701087609, updateTime=1793340598242, updator=13701087609, issue=Issue{id=1322929547464815391, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='14', pageStart='2385', pageEnd='2576', issueExtLink='null', onlineDate='null', pubDate='1784908800000', pubDateStr='2026-07-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793340582958, creator='13701087609', updateTime=1793343111003, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940150912790807, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929547464815391, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940150912790808, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929547464815391, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2489, endPage=2494, ext={EN=ArticleExt(id=1322929611998372808, articleId=1322929611570553799, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Evidence summary of transition from nasogastric tube feeding to oral feeding in children, columnId=1220689487877821128, journalTitle=Chinese Nursing Research, columnName=Interdisciplinary Nursing Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To summarize the evidence on the transition from nasogastric tube feeding to oral feeding in children.

Methods

Clinical decisions,guidelines,evidence summaries,systematic reviews, and expert consensus reports on the transition from nasogastric tube feeding to oral feeding in children were retrieved from Chinese and English databases,as well as various nursing associations and guideline websites.The search period was from the establishment of the databases to June 15,2025.Two researchers trained in evidence-based knowledge performed quality evaluation,evidence extraction,summarization,and grading of the included literature.

Results

A total of 5 papers were included,consisting of 1 expert consensus,2 systematic reviews,1 guideline,and 1 clinical decision.A total of 14 pieces of evidence were summarized across four aspects,namely assessment,swallowing function intervention,formulation of transitional feeding plans,and health education.

Conclusions

This study summarized the evidence related to the transition from nasogastric tube feeding to oral feeding in children,which is expected to provide a reference for evidence-based practice for clinical nursing staff,assist children with nasogastric tube feeding in successfully transitioning to oral feeding,and improve patient prognosis.

, authors=Jingxuan ZHANG1, 2, Fangping WANG1, Zhitian XIAO1, Xiaoqin TIAN1, Ling AO1, Jinghua YE1, Linlin SUN1, authorsList=Jingxuan ZHANG, Fangping WANG, Zhitian XIAO, Xiaoqin TIAN, Ling AO, Jinghua YE, Linlin SUN, authorCompany=null, correspAuthors=Fangping WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322929612405220298, articleId=1322929611570553799, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=儿童鼻胃管喂养向经口喂养过渡的证据总结, columnId=1220689488053981904, journalTitle=护理研究, columnName=交叉护理学研究, runingTitle=null, highlight=null, articleAbstract=
目的

总结儿童鼻胃管喂养向经口喂养过渡的证据。

方法

系统检索中英文数据库及各个护理学会和指南网站中与儿童鼻胃管喂养向经口喂养过渡的临床决策、指南、证据总结、系统评价、专家共识，检索时限为建库至2025年6月15日。由2名经过循证相关知识培训的研究人员对纳入文献进行质量评价、证据提取、汇总及分级。

结果

共纳入5篇文献，包括1篇专家共识、2篇系统评价、1篇指南、1篇临床决策。总结获得评估、吞咽功能干预、过渡期喂养方案的制定和健康教育4个方面的14条证据。

结论

总结的儿童鼻胃管喂养向经口喂养过渡的相关证据有利于为后期临床护理人员的循证实践提供参考，帮助鼻胃管喂养儿童成功过渡至经口喂养，促进患儿预后。

, authors=张静萱1, 2, 王芳萍1, *, *, 肖志田1, 田小琴1, 敖玲1, 叶敬花1, 孙琳琳1, authorsList=张静萱, 王芳萍, 肖志田, 田小琴, 敖玲, 叶敬花, 孙琳琳, authorCompany=null, correspAuthors=王芳萍, authorNote=

张静萱，护士，硕士研究生在读

, correspAuthorsNote=
王芳萍，E-mail:
WANG Fangping, E-mail:
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张静萱，护士，硕士研究生在读

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Basic characteristics of the included literature（n=5）

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纳入文献国家文献类型文献来源文献主题
Taylor等[6]2019新西兰系统评价PubMed儿童从管饲过渡到口服喂养
候梅等[13]2023中国专家共识万方数据库儿童康复临床中喂养障碍的评估及管理
Killian等[14]2023美国系统评价PubMed儿童成功拔除鼻胃管的管理
钱素云等[15]2018中国指南中国知网危重症儿童营养评估及支持治疗
Boullata等[16]2017美国临床决策PubMed美国肠外肠内营养学会（ASPEN）肠内营养治疗安全规范
), ArticleFig(id=1322929620470865924, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929611570553799, language=CN, label=表1, caption=

纳入文献的基本特征（n=5）

, figureFileSmall=null, figureFileBig=null, tableContent=
纳入文献国家文献类型文献来源文献主题
Taylor等[6]2019新西兰系统评价PubMed儿童从管饲过渡到口服喂养
候梅等[13]2023中国专家共识万方数据库儿童康复临床中喂养障碍的评估及管理
Killian等[14]2023美国系统评价PubMed儿童成功拔除鼻胃管的管理
钱素云等[15]2018中国指南中国知网危重症儿童营养评估及支持治疗
Boullata等[16]2017美国临床决策PubMed美国肠外肠内营养学会（ASPEN）肠内营养治疗安全规范
), ArticleFig(id=1322929620571529222, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929611570553799, language=EN, label=Table 2, caption=

Evidence summary of transition from nasogastric tube feeding to oral feeding in children

, figureFileSmall=null, figureFileBig=null, tableContent=
证据主题证据内容证据等级推荐强度
评估1）监测吞咽能力、营养和水电解质状态以及呼吸并发症，并酌情调整肠内营养[16]4级A级
2）建议营养风险筛查使用约克郡营养不良评分（PYMS），也可使用儿童营养风险及发育不良筛查工具（STRONGkids）或儿科营养不良评估筛查工具(STAMP)[15]4级A级
3）在鼻胃管喂养向经口喂养过渡阶段，至少每周测量1次体重，以确保摄入足够的热量达到体重目标[16]5级A级
吞咽功能干预4）针对口咽性吞咽困难的患儿，推荐使用神经肌肉电刺激治疗，刺激舌骨上下肌群的肌肉收缩，以改善吞咽困难和喂养能力[13]5级B级
5）采用生物反馈治疗技术，在进食和吞咽期间提供同步视觉反馈，以强化吞咽技巧、力量和协调性[13]5级B级
过渡期喂养方案的制定6）建议通过跨学科团队（如言语与语言治疗师、营养师等）的协作，评估患儿的吞咽能力及不同食物质地下的误吸风险，制定安全的口服喂养方案。在口服摄入的初始阶段，提供经过必要调整的个性化饮食[16]5级A级
7）记录所有已识别的与经口喂养相关的问题[16]5级B级
8）在从管饲过渡至经口喂养前，需确保患儿具备足够的饥饿提示及口腔运动技能。建议逐步减少管饲喂养量，当经口摄入达到目标热量的75%以上时，可考虑停止管饲[13]5级A级
9）饥饿诱导策略在促进停止管饲方面具有明显效果[6,14]1级B级
10）在鼻胃管喂养关闭期间协调口服喂养，以刺激食欲。建议采用间歇性鼻胃管喂养作为餐后补充，或采用夜间连续喂养，两者可单独使用也可组合使用（白天餐后补充，夜间持续泵入）[16]5级A级
11）当医疗、营养、口腔感觉运动等方面稳定，喂养障碍仍然存在时，建议采用行为干预促进成功过渡[13]5级A级
12）当患儿能够通过口服摄入满足大部分能量需求时，可考虑取消鼻胃管喂养方案[16]5级A级
健康教育13）通过循序渐进的示范和反馈方法，指导照顾者学习过渡期相关的喂养技巧，确保顺利过渡[6]5级A级
14）指导照顾者帮助患儿避免进餐时分心、保持愉快的进食态度、限制进餐时间、两餐之间仅补充水分、提供与年龄相匹配的食物、系统引入新食物、鼓励自我喂养，并接受符合年龄的无序进食行为[13]5级A级
), ArticleFig(id=1322929620655415303, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929611570553799, language=CN, label=表2, caption=

儿童鼻胃管喂养向经口喂养过渡的证据总结

, figureFileSmall=null, figureFileBig=null, tableContent=
证据主题证据内容证据等级推荐强度
评估1）监测吞咽能力、营养和水电解质状态以及呼吸并发症，并酌情调整肠内营养[16]4级A级
2）建议营养风险筛查使用约克郡营养不良评分（PYMS），也可使用儿童营养风险及发育不良筛查工具（STRONGkids）或儿科营养不良评估筛查工具(STAMP)[15]4级A级
3）在鼻胃管喂养向经口喂养过渡阶段，至少每周测量1次体重，以确保摄入足够的热量达到体重目标[16]5级A级
吞咽功能干预4）针对口咽性吞咽困难的患儿，推荐使用神经肌肉电刺激治疗，刺激舌骨上下肌群的肌肉收缩，以改善吞咽困难和喂养能力[13]5级B级
5）采用生物反馈治疗技术，在进食和吞咽期间提供同步视觉反馈，以强化吞咽技巧、力量和协调性[13]5级B级
过渡期喂养方案的制定6）建议通过跨学科团队（如言语与语言治疗师、营养师等）的协作，评估患儿的吞咽能力及不同食物质地下的误吸风险，制定安全的口服喂养方案。在口服摄入的初始阶段，提供经过必要调整的个性化饮食[16]5级A级
7）记录所有已识别的与经口喂养相关的问题[16]5级B级
8）在从管饲过渡至经口喂养前，需确保患儿具备足够的饥饿提示及口腔运动技能。建议逐步减少管饲喂养量，当经口摄入达到目标热量的75%以上时，可考虑停止管饲[13]5级A级
9）饥饿诱导策略在促进停止管饲方面具有明显效果[6,14]1级B级
10）在鼻胃管喂养关闭期间协调口服喂养，以刺激食欲。建议采用间歇性鼻胃管喂养作为餐后补充，或采用夜间连续喂养，两者可单独使用也可组合使用（白天餐后补充，夜间持续泵入）[16]5级A级
11）当医疗、营养、口腔感觉运动等方面稳定，喂养障碍仍然存在时，建议采用行为干预促进成功过渡[13]5级A级
12）当患儿能够通过口服摄入满足大部分能量需求时，可考虑取消鼻胃管喂养方案[16]5级A级
健康教育13）通过循序渐进的示范和反馈方法，指导照顾者学习过渡期相关的喂养技巧，确保顺利过渡[6]5级A级
14）指导照顾者帮助患儿避免进餐时分心、保持愉快的进食态度、限制进餐时间、两餐之间仅补充水分、提供与年龄相匹配的食物、系统引入新食物、鼓励自我喂养，并接受符合年龄的无序进食行为[13]5级A级
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儿童鼻胃管喂养向经口喂养过渡的证据总结
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张静萱 1, 2 , 王芳萍 1, *, * , 肖志田 1 , 田小琴 1 , 敖玲 1 , 叶敬花 1 , 孙琳琳 1
护理研究 | 交叉护理学研究 2026,40(14): 2489-2494
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护理研究 |交叉护理学研究 2026 , 40 (14) : 2489 -2494
儿童鼻胃管喂养向经口喂养过渡的证据总结
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张静萱1, 2, 王芳萍1, *, * , 肖志田1, 田小琴1, 敖玲1, 叶敬花1, 孙琳琳1
作者信息
  • 1深圳市儿童医院，广东 518026
  • 2中国医科大学护理学院
通讯作者:
王芳萍，E-mail:
WANG Fangping, E-mail:
作者简介:

张静萱，护士，硕士研究生在读

Evidence summary of transition from nasogastric tube feeding to oral feeding in children
Jingxuan ZHANG1, 2, Fangping WANG1 , Zhitian XIAO1, Xiaoqin TIAN1, Ling AO1, Jinghua YE1, Linlin SUN1
Affiliations
  • 1Shenzhen Children's Hospital, Guangdong 518026 China
  • 2School of Nursing, China Medical University
出版时间: 2026-07-25 doi: 10.12102/j.issn.1009-6493.2026.14.014
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摘要
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目的

总结儿童鼻胃管喂养向经口喂养过渡的证据。

方法

系统检索中英文数据库及各个护理学会和指南网站中与儿童鼻胃管喂养向经口喂养过渡的临床决策、指南、证据总结、系统评价、专家共识，检索时限为建库至2025年6月15日。由2名经过循证相关知识培训的研究人员对纳入文献进行质量评价、证据提取、汇总及分级。

结果

共纳入5篇文献，包括1篇专家共识、2篇系统评价、1篇指南、1篇临床决策。总结获得评估、吞咽功能干预、过渡期喂养方案的制定和健康教育4个方面的14条证据。

结论

总结的儿童鼻胃管喂养向经口喂养过渡的相关证据有利于为后期临床护理人员的循证实践提供参考，帮助鼻胃管喂养儿童成功过渡至经口喂养，促进患儿预后。

儿童  /  鼻胃管喂养  /  经口喂养  /  过渡期护理  /  证据总结  /  循证护理
Objective

To summarize the evidence on the transition from nasogastric tube feeding to oral feeding in children.

Methods

Clinical decisions,guidelines,evidence summaries,systematic reviews, and expert consensus reports on the transition from nasogastric tube feeding to oral feeding in children were retrieved from Chinese and English databases,as well as various nursing associations and guideline websites.The search period was from the establishment of the databases to June 15,2025.Two researchers trained in evidence-based knowledge performed quality evaluation,evidence extraction,summarization,and grading of the included literature.

Results

A total of 5 papers were included,consisting of 1 expert consensus,2 systematic reviews,1 guideline,and 1 clinical decision.A total of 14 pieces of evidence were summarized across four aspects,namely assessment,swallowing function intervention,formulation of transitional feeding plans,and health education.

Conclusions

This study summarized the evidence related to the transition from nasogastric tube feeding to oral feeding in children,which is expected to provide a reference for evidence-based practice for clinical nursing staff,assist children with nasogastric tube feeding in successfully transitioning to oral feeding,and improve patient prognosis.

children  /  nasogastric tube feeding  /  oral feeding  /  transitional care  /  evidence summary  /  evidence-based nursing
张静萱, 王芳萍, 肖志田, 田小琴, 敖玲, 叶敬花, 孙琳琳. 儿童鼻胃管喂养向经口喂养过渡的证据总结. 护理研究, 2026 , 40 (14) : 2489 -2494 . DOI: 10.12102/j.issn.1009-6493.2026.14.014
Jingxuan ZHANG, Fangping WANG, Zhitian XIAO, Xiaoqin TIAN, Ling AO, Jinghua YE, Linlin SUN. Evidence summary of transition from nasogastric tube feeding to oral feeding in children[J]. Chinese Nursing Research, 2026 , 40 (14) : 2489 -2494 . DOI: 10.12102/j.issn.1009-6493.2026.14.014
正文
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鼻胃管喂养是通过鼻腔插入胃内的导管将流质营养物质直接输送到胃内的肠内营养支持方式[1]。患儿因疾病导致机体功能减退，出现进食困难及消化系统功能障碍，直接影响康复进程。因此，早期进行鼻胃管喂养，根据营养状况制订个性化的营养计划，有助于提升患儿存活率并优化远期预后[2-3]。尽管早期对患儿进行鼻胃管喂养有益，但长期留置胃管也会导致患儿出现胃肠道不耐受、胃肠道功能障碍、吞咽功能退化、误吸、鼻腔刺激和鼻黏膜溃疡等危害[4-5]。因此，需积极促进患儿从鼻胃管喂养过渡到经口喂养，进而促进口腔和吞咽功能恢复以及胃肠道正常生理功能发育，增强患儿自主性和心理安全感，为患儿的全面康复和长期健康奠定基础[6]。儿童鼻胃管喂养向经口喂养的过渡期指患儿从完全依赖管饲逐步恢复自主进食能力的阶段[7]。已有研究表明，全球范围内儿童经口喂养过渡成功率存在较大差异（34%~89%），且缺乏统一的评估工具与标准化干预流程[8]，这在一定程度上限制了临床护理人员在实际操作中的规范性和灵活性。因此，本研究聚焦于儿童鼻胃管喂养向经口喂养过渡的临床实践，通过系统检索国内外相关文献，提取并整合最佳证据，旨在完善这一领域的管理规范，为临床护理人员提供更具针对性和实用性的循证实践参考，促进患儿喂养功能康复，改善长期预后。
1　资料与方法
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1.1　确立循证问题
采用PIPOST模式确定研究问题。目标人群（population，P）为留置鼻胃管的儿童；干预措施（intervention，I）为促进鼻胃管喂养向经口喂养成功过渡的干预措施；专业人员（professionals，P）为医护人员；结局指标（outcome，O）为经口喂养过渡成功率、留置胃管时长等；证据应用场所（setting，S）为神经内科病房；证据类型（type of evidence，T）为临床决策、指南、证据总结、系统评价、专家共识。本研究已在复旦大学循证护理中心注册（项目注册号：ES20257504）。
1.2　文献检索策略
通过计算机检索中英文数据库及各个护理学会和指南网站，按照“6S”证据金字塔模型由上至下检索国际指南网、医脉通指南网、加拿大安大略护理学会网站、英国国家卫生与临床优化研究所网站、PubMed、Web of Science、UpToDate、Cochrane Library、万方数据库、中国知网、维普、中国生物医学文献服务系统，检索时限为建库至2025年6月15日。按照主题词与自由词相结合的方式检索，同时进行引文追溯。中文检索词为：“儿童/患儿/儿科/青少年”“鼻胃管/胃管/肠内营养/营养支持/肠内喂养/经口喂养/过渡”“临床决策/指南/证据总结/系统评价/专家共识/Meta分析”。英文检索词为：“child/child patient/pediatric/adolescent”“nasogastric tube/gastric tube/enteral nutrition/nutritional support/enteral feeding/oral feeding/transition”“best practice/guideline/evidence summary/systematic review/expert consensus/Meta analysis”。以PubMed为例，检索式如下：
#1 （（（child[MeSH Terms]） OR （"child patient"[Title/Abstract]）） OR （pediatric[Title/Abstract]）） OR （adolescent[Title/Abstract]）
#2 （（（（（（"nasogastric tube"[Title/Abstract]） OR （"gastric tube"[Title/Abstract]）） OR （"enteral nutrition"[Title/Abstract]）） OR （"enteral feeding"[Title/Abstract]）） OR （"nutritional support"[Title/Abstract]）） OR （"oral feeding"[Title/Abstract]）） OR （transition[Title/Abstract]）
#3 （（（（（"best practice"[Title/Abstract]） OR （guideline[Title/Abstract]）） OR （"evidence summary"[Title/Abstract]）） OR （"systematic review"[Title/Abstract]）） OR （"expert consensus"[Title/Abstract]）） OR （"Meta analysis"[Title/Abstract]）
#4 #1 AND #2 AND #3
1.3　文献纳入与排除标准
由2名经过循证相关知识培训的研究人员根据文献纳入及排除标准筛选文献，如存在分歧则由小组讨论后最终确定筛选结果。纳入标准：1）研究对象为留置鼻胃管的儿童；2）研究内容为促进儿童鼻胃管喂养向经口喂养过渡的护理措施；3）研究类型为临床决策、指南、证据总结、系统评价、专家共识；4）语种为中文或英文。排除标准：1）重复发表或已有更新版本；2）无法获取全文数据。
1.4　文献质量评价
由2名经过循证相关知识培训且曾经参与过文献质量评价的研究人员对纳入文献进行质量评价，如存在分歧则由小组讨论后得出最终结果。1）临床决策、证据总结：采用证据总结的评价工具（CASE）进行评价[9]。2）指南：采用临床指南研究与评价系统Ⅱ（Appraisal of Guidelines for Research and EvaluationⅡ，AGREEⅡ）进行评价。该评价系统由6个领域（范围和目的、参与人员、严谨性、清晰性、适用性、独立性）和23个条目构成，每个条目1~7分，1分表示指南完全不符合该条目，7分表示指南完全符合该条目，各领域得分标准化百分比越高说明指南质量越高[10]。3）系统评价：采用澳大利亚乔安娜布里格斯研究所（JBI）循证卫生保健中心（2016）针对系统评价的真实性评价工具进行评价，包含11个条目[11]。4）专家共识：采用澳大利亚JBI循证卫生保健中心（2016）针对意见和共识类文章的真实性评价工具进行评价，包含6个条目[11]。
1.5　证据提取与汇总
由2名研究人员对证据进行提取，包括文献作者、发表年份、国家、文献来源、文献类型以及证据内容等。若在提取过程中存在分歧，由研究小组共同讨论后确定最终的证据内容。在进行证据整合时，若不同研究结果指向相同结论，优先选用表述清晰、便于理解的研究证据，以提高信息的传播效率和受众接受度；若证据结论存在冲突，则需遵循循证医学原则，优先采纳高质量、近期发表的证据，确保决策依据的科学性和时效性；当证据结论相互补充时，应依据逻辑关联性进行系统整合，以构建连贯、完整的证据链，为临床实践或研究提供全面支持[11]。
1.6　证据分级及推荐级别
根据2014年版JBI证据预分级系统，将临床决策、指南、系统评价及专家共识提取的证据分为5个级别，1级为随机对照试验/其他试验性研究，2级为类试验研究，3级为观察性-分析性研究，4级为观察性-描述性研究，5级为专家意见/基础研究[12]。从指南提取的证据推荐等级确定依据为：若6个领域均≥60%，评为强推荐（A级）；若<30%的领域数≥3个，评为弱推荐（C级）；其余情况评为较弱推荐（B级）[10]。从临床决策、系统评价及专家共识提取的证据由研究小组成员依据证据的FAME属性（可行性、适宜性、临床意义及有效性）进行推荐级别划分，分为强烈推荐（A级）和弱推荐（B级）[12]。
2　结果
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2.1　文献检索结果及纳入文献的基本特征
初步检索获得2 973篇文献，剔除重复及不符合标准的文献后，最终纳入5篇文献[6,13-16]，包括1篇专家共识[13]、2篇系统评价[6,14]、1篇指南[15]、1篇临床决策[16]。纳入文献的基本特征见表1。
2.2　纳入文献的质量评价
纳入1篇专家共识[13]，所有条目均评价为“是”，整体质量较好，准予纳入。纳入2篇系统评价[6,14]，其中Killian等[14]系统评价的条目5评价为“不清楚”，其他条目均评价为“是”，准予纳入；Taylor等[6]系统评价的条目8评价为“不清楚”，其他条目均评价为“是”，准予纳入。纳入1篇指南[15]，6个领域标准化百分比均≥60%（范围和目的为100.00%，参与人员为85.71%，严谨性为96.43%，清晰性为100.00%，适用性为64.29%，独立性为100.00%），准予纳入。纳入1篇临床决策[16]，条目3、条目4、条目8均评价为“部分符合”，其他条目均评价为“是”。
2.3　证据汇总
对儿童鼻胃管喂养向经口喂养的相关证据进行汇总，最终纳入14条证据，分为评估、吞咽功能干预、过渡期喂养方案的制定和健康教育4个方面，见表2。
3　讨论
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3.1　科学评估留置鼻胃管儿童的营养及吞咽状况
科学评估留置鼻胃管儿童的营养及吞咽状况是成功过渡至经口喂养的基础。证据1~证据3包括了营养及吞咽状况的评估内容。过渡期患儿可能因经口摄入不足或喂养技能不成熟而面临能量或蛋白质缺乏、脱水或电解质紊乱的风险，故定期评估患儿的营养及吞咽状况必不可少。已有研究表明，通过对体重、水电解质、吞咽功能等多项指标进行动态评估，有利于及时调整鼻胃管与经口喂养的比例，促进成功过渡[7]。已有研究结果表明，营养风险筛查工具在儿童从鼻胃管喂养向经口喂养过渡过程中具有重要的临床意义[15]。临床上常用STRONGkids和STAMP进行儿童营养风险筛查。STAMP灵敏度较高、评估较全面，但操作复杂；STRONGkids简便快捷、特异性较高，但灵敏度较低且依赖主观判断。临床可根据需求选择，快速筛查用STRONGkids，精准评估用STAMP[17]。儿童在过渡期可能因能量摄入不足或代谢需求增加而出现营养相关问题，通过筛查工具可提前识别高风险患儿，调整喂养方式，减少并发症发生。基于现有证据，未来可通过多维度的营养及吞咽状况评估，促进儿童鼻胃管喂养向经口喂养的成功过渡。
3.2　过渡期吞咽功能的干预
长期留置鼻胃管的儿童会因缺乏经口进食刺激导致吞咽相关肌肉发生失用性萎缩、神经反射退化，同时鼻胃管的机械性干扰会阻碍正常的吞咽功能恢复，最终引发吞咽困难及鼻胃管依赖[18]。吞咽功能干预通过降低误吸风险、促进口腔运动及改善吞咽功能状况，帮助依赖鼻胃管的儿童安全过渡至经口喂养。证据4和证据5主要针对吞咽困难患儿提出干预措施。神经肌肉电刺激治疗是通过外部电流刺激神经或肌肉，直接引发肌肉被动收缩，是用于改善肌肉萎缩、增强肌力或辅助功能恢复的康复技术[19]。神经肌肉电刺激技术对改善患儿吞咽功能障碍具有明显疗效，可以诱导患儿神经功能恢复，改善营养状态[20]。具体操作方法为：使用吞咽神经和肌肉电刺激仪，在下颌与舌骨连线中点及舌骨上缘放置2个主电极负极，在两电极连线底边的等边三角形顶点处放置参考电极。频率设置为30~80 Hz，刺激时间为每次4 s，强度为5~25 mA（根据耐受调整），间歇6 s，每次治疗20 min，每日1次，持续4周[20]。生物反馈治疗技术是一种通过视觉、听觉或触觉反馈，使病人能够主动控制生理过程的技术，包括表面肌电图等技术。近年来，该技术在吞咽障碍病人的康复中得到了广泛应用，尤其是在成人和老年人中应用较多，其在儿童中的应用近年来逐渐受到关注[21]。Bykova[22]研究表明，表面肌电图技术在改善患儿吞咽功能方面具有有效性。通过实时监测并反馈吞咽相关肌肉的电活动，可以帮助患儿在生物反馈训练中主动调整吞咽动作，增强肌肉协调性和力量，同时结合针对性吞咽训练可促进神经肌肉控制，从而改善吞咽功能。神经肌肉电刺激疗法通过电刺激增强吞咽肌力，而表面肌电图技术提供实时反馈帮助患儿主动调整吞咽动作，两者协同可提升肌肉协调性，促进神经重塑，并减少误吸风险。两种疗法联合兼具被动刺激与主动训练的优势，有利于提高病人治疗依从性，改善病人吞咽功能和生活质量[23]。未来可早期进行吞咽功能干预，促进鼻胃管喂养儿童成功过渡至经口喂养。
3.3　过渡期喂养方案的制定及优化
科学化的喂养方案是儿童从鼻胃管喂养向经口喂养顺利过渡的核心保障。证据6~证据12涵盖了过渡期喂养方案的多个方面，包括构建跨学科团队、饥饿诱导、行为干预等。可由医生、心理学家、营养师、言语与语言治疗师等专业人员组成跨学科团队，共同协作以支持患儿从鼻胃管过渡到经口喂养。饥饿诱导和行为干预是过渡期成功的关键措施。饥饿诱导的核心是通过减少管饲量激发患儿饥饿感，从而增加其进食动机，涉及逐步减少管饲量、控制饥饿感、监测体重和健康状况等内容。已有研究结果显示，通过饥饿诱导，平均79%的患儿实现成功过渡[6]。但针对危重症或合并多种并发症的患儿需慎重使用饥饿诱导相关证据。行为干预的具体措施包括：采用正强化技术（如即时表扬、奖励机制等）以增强食物接受、咀嚼及吞咽等适应性行为；采用消退程序（如渐进式食物接触等）以减少拒食相关的问题行为；通过环境优化（如适配食物质地、调整餐具选择等）降低外部阻力以提升进食依从性。通过行为干预，平均34%的患儿可实现成功过渡[6]。此外，间歇性鼻胃管喂养在维持患儿营养供给的同时会降低长期置管引发的食欲减退及摄食抗拒现象。该喂养方式通过建立规律的进食反射周期，能够有效激发患儿自主经口摄食意愿，促进消化道功能适应性恢复[18]。已有研究表明，当患儿经口摄入达到目标热量的75%以上时，可以考虑拔除鼻胃管[24]。基于以上证据，未来可以制定更加合理的过渡期喂养方案，为后期的临床实践提供理论参考。
3.4　加强健康教育，提升过渡期照护质量
照顾者在帮助患儿从鼻胃管过渡到经口喂养的过程中扮演着至关重要的角色，对患儿照顾者实施健康教育具有重要意义。证据13和证据14涉及对照顾者实施健康教育的重要性及其内容。通过循序渐进的示范和反馈方法指导照顾者学习过渡期相关喂养技巧，有利于确保顺利过渡。该过程先由医务人员向照顾者示范过渡期喂养技巧，了解如何正确实施喂养策略[6]。随着逐渐熟悉流程，由照顾者亲自实施，同时医务人员对照顾者的能力作出相应评估。照顾者的参与不仅有利于改善儿童的进食行为，还能减少照顾者的压力和焦虑，提升家庭生活质量[25]。此外，照顾者的参与程度会影响过渡效果，部分照顾者会因压力大、时间不充足以及对喂养技巧不熟悉导致其照顾的患儿向经口喂养过渡失败。未来建议积极关注照顾者参与的效果评估，包括照顾者的参与程度、对喂养技巧的熟悉度等。过渡期强调在建立互动型喂养模式的过程中，照顾者应以动态回应患儿需求为核心，既重视其饮食意愿的表达，又注重培养独立进食能力[13]。应渐进式引导患儿，重建患儿对经口进食的信任与能力。应指导过渡期患儿与照顾者形成互动性喂养模式，促进成功过渡。
4　小结
收起
本研究对儿童鼻胃管喂养向经口喂养过渡的相关证据进行汇总，最终纳入评估、吞咽功能干预、过渡期喂养方案的制定和健康教育4个方面的14条证据，可为后期循证实践提供参考。本研究引用的证据部分来源于国外，不同文化背景下患儿照顾者对证据的接受度不同，我国护理人员应根据具体情况，审慎选择适用的证据进行临床实践。

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2026年第40卷第14期
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doi: 10.12102/j.issn.1009-6493.2026.14.014
  • 接收时间：2025-08-01
  • 首发时间：2026-10-30
  • 出版时间：2026-07-25
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  • 收稿日期：2025-08-01
  • 修回日期：2026-04-20
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    1深圳市儿童医院，广东 518026
    2中国医科大学护理学院

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王芳萍，E-mail:
WANG Fangping, E-mail:
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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