Objective:To construct a perioperative activity program for patients with minimally invasive esophageal cancer under enhanced recovery after surgery (ERAS) concept through literature review and Delphi method.Methods:This was a single-center and interview study. Databases and websites including PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Medive and other databases and websites were searched systematically for articles related to esophageal cancer and upper digestive tract cancer patients′ activities from January 1, 2002 to January 31, 2022. In this single-center and interview study, literature review and group discussion were conducted to form a preliminary activity program, and then Delphi method was used to further demonstrate the practicability and feasibility of the activity program.Results:The overall program and specific intervention methods of perioperative activity program for minimally invasive esophageal cancer patients under ERAS concept were constructed, including 3 first-level indicators, 9 second-level indicators and 35 third-level indicators.Conclusions:Perioperative activity program of patients with minimally invasive esophageal cancer is scientific and reasonable, which can provide reference for medical staff and patients.

Objective To explore the factors influencing enteral nutrition intolerance in critically ill patients and to develop a risk prediction model to provide medical staff with a tool for early identification of patient intolerance.Methods Domestic and international databases such as CNKI,PubMed and Web of Science were searched and supplemented by searching references and grey literature.The search period was from inception to November 2022.Data were independently screened and extracted by 2 systematically trained researchers,and the quality of the literature was evaluated.Meta-analysis was performed using Review Manager 5.4 software.The OR value of the comprehensive effect of the factors was taken as the coefficient of each factor in the formula,and the natural logarithm of the ratio of intolerance incidence and non-incidence was the constant term of the formula.From December 2022 to June 2023,360 patients who met the inclusion and exclusion criteria in the ICU of a tertiary hospital were collected as a model verification group by convenient sampling method,and the collected clinical data were substituted into the formula to evaluate the discrimination and calibration of the model.Results A total of 13 articles were included.7 influencing factors with more than 3 times of reports and statistically significant results were obtained.For age[OR=0.97,95％CI(0.94,0.99),P=0.010],Acute Physiology and Chronic Health Evaluation scoreⅡ[OR=1.17,95％CI(1.01,1.36),P=0.040],comorbidity with diabetes[OR=1.21,95％CI(1.05,1.40),P=0.008],comor-bidity with neurological diseases[OR=0.85,95％CI(0.74,0.98),P=0.020],mechanical ventilation[OR=3.21,95％CI(1.82,5.66),P＜0.001],using sedative analgesics[OR=2.27,95％CI(1.66,3.10),P＜0.001],using gastric motility drugs[OR=0.23,95％CI(0.15,0.36),P＜0.001].The incidence of enteral nutrition intolerance was 35.00％.The risk prediction model for enteral nutrition intolerance in critically ill patients was logit(P)=-0.619-0.031×age+0.157 × APACHE Ⅱ+0.191 ×comorbidity with diabetes-0.163 ×comorbidity with neurosurgery+0.820 ×using sedatives and analgesics+1.166×mechanical ventilation-1.470×using gastric dynamic drugs.The area under the receiver operating characteristic curve of the model was 0.864.The maximum Youden index was 0.589.The sensitivity was 0.922.The specificity was 0.667.The corresponding clinical diagnostic threshold was 0.536.Hosmer-Leme-show test x2=13.410,P=0.098.Brier score was 0.195.Conclusion The risk prediction model of enteral nutrition intolerance in critically ill patients based on large sample evidence-based medicine is universal,scientific and practical.It provides a tool for medical staff to identify patients with enteral nutrition feeding intolerance in ICU.