肠内营养泵鼻饲和间歇灌注鼻饲减少肠内营养并发症效果的Meta分析  

Effects of Enteral Feeding Pump and Intermittent Bolus Nasogastric Feeding on Reducing Complications of Enteral Nutrition: A Meta-Analysis

作　　者：杨建国[1] 张军[1] 杨宝义[2] 方敏[3] 吕奕君 

机构地区：[1]武汉大学HOPE护理学院,武汉430071 [2]蚌埠医学院护理学系,安徽蚌埠233030 [3]湖北医药学院附属太和医院,湖北十堰442000

出　　处：《中国循证医学杂志》2014年第2期197-204,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价肠内营养泵鼻饲和间歇灌注鼻饲减少肠内营养并发症的效果。方法计算机检索PubMed（1980～2013．9）、WileyOnlineLibrary（1990—2013．9）、Elsevier（1990～2013．9）、CNKI（1990—2013．9）、VIP（1990～2013．9）和WanFangData（1990-2013．9），查找比较肠内营养泵鼻饲和间歇灌注鼻饲的随机对照试验（RCT）。由2位研究者根据纳入与排除标准独立进行文献筛选、资料提取及质量评价，然后采用RevMan5．2．6软件进行Meta分析。结果最终共纳入16个研究，包括1263例患者。Meta分析结果显示：肠内营养泵鼻饲法在降低胃潴留[OR=0．27，95％CI（0．16，0．45），P〈0．00001]、腹泻[OR=0．24，95％CI（0．16，0．34），P〈0．00001]、返流[OR=0．26，95％CI（0．11，0．65），P=0．004]、误吸[OR=0．19，95％CI（0．11，0．32），P〈0．00001]、吸入性肺炎[OR=0．40，95％CI（0．23，0．68），P=0．0007]和腹胀[OR=0．24，95％CI（0．10，0．57），P=0．001]发生率方面均优于间歇灌注鼻饲法，其差异均具有统计学意义；但在减少堵管发生率方面，两者无明显差异[OR=0．43，95％CI（0．14，1．29），P=0．13]。结论现有证据提示，肠内营养泵鼻饲法在一定程度上可降低肠内营养患者并发症的发生率，其效果优于间歇灌注鼻饲法。但由于纳入研究的方法学质量不高，证据强度不足，上述结论尚需今后开展大样本、多中心、高质量的RCT加以验证。Objective To systematically review the effects of enteral feeding pump and intermittent bolus nasogastric feeding on gastric retention, diarrhea, regurgitation, and other complications of patients who received enteral nutrition treatment. Methods We electronically searched databases including PubMed （1980-2013.9）, Wiley Online Library （1990-2013.9）, Elsevier （1990-2013.9）, CNKI （1990-2013.9）, VIP （1989-2013.9） and WanFang Data （1990-2013.9）, to collect randomized controlled trials （RCTs） about enteral feeding pump and intermittent bolus nasogastric feeding. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of the included studies, and then meta-analysis was performed using RevMan 5.2.6 software. Results A total of 16 trials involving 1 263 patients were finally included. The results of meta-analysis indicated that enteral feeding pump was better than intermittent bolus nasogastric feeding in the incidences of gastric retention （OR=0.27, 95%CI 0.16 to 0.45, P〈0.000 01）, diarrhea （OR=0.24, 95%CI 0.16 to 0.34, P〈0.000 01）, regurgitation （OR=0.26, 95%CI 0.11 to 0.65, P=0.004）, aspiration （OR=0.19, 95%CI 0.11 to 0.32, P〈0.000 01）, aspiration pneumonia （OR=0.40, 95%CI 0.23 to 0.68, P=0.000 7）, and abdominal distension （OR=0.24, 95%CI 0.10 to 0.57, P=0.001）, with significant differences. However, they were alike in the incidence of tub obstruction （OR=0.43, 95%CI 0.14 to 1.29, P=0.13）. Conclusion According to existing relevant RCTs, enteral feeding pump is better than intermittent bolus nasogastric feeding in reducing enteral nutrition complications to some extent. However, due to the low methodological quality of the included studies, more large-scale, multicentre high quality RCTs are still needed to verify the aforementioned conclusion.

关 键 词：肠内营养 肠内营养泵 鼻饲 系统评价 META分析 随机对照试验 

分 类 号：R459.3[医药卫生—治疗学]