肝移植术后鼻胃（肠）置管与经皮内镜下胃空肠造瘘置管肠内营养效果的Meta分析  

Effect of enteral nutrition via a naso-gastric（intestinal） tube vs a percutaneous endoscopic gastrostomy/jejunostomy tube in patients after liver transplantation： a Meta analysis

作　　者：鲁华鹏 肖奇贵 王婧 杨勤玲[1] 郑鑫[1] 刘培培 李津 Lu Huapeng;Xiao Qigui;Wang Jing;Yang Qinling;Zheng Xin;Liu Peipei;Li Jin(Department of Hepatobiliary Surgery,The First Affiliated Hospital,Xi＇an Jiaotong University,Xi＇an 710061,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,西安710061 [2]西安交通大学医学部护理系

出　　处：《中华肝胆外科杂志》2018年第11期751-756,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金（81572733）;西安交通大学第一附属医院发展基金资助（2017HL-04）

摘　　要：目的系统评价肝移植术后鼻胃（肠）管（NG）与经皮内镜下胃空肠造瘘（PEG/PEJ）置管肠内营养效果，为移植术后选择恰当营养途径提供支持。方法检索Pub Med、Web of Science、Cochrane Library（2018年1期）、知网、维普、万方等数据库，收集2018年1月前肝移植术后有关NG与PEG/PEJ置管肠内营养的回顾性研究。由2位研究者独立评价文献并提取数据，分歧通过第三方协商解决，用RevMan5.3进行Meta分析。结果共纳入4篇研究，430例患者。Meta分析显示PEG/PEJ置管患者营养管开始使用时间早于NG患者[MD＝－1.77，95%CI（－1.83，－1.70），P〈0.05]，平均住院时间短于NG患者[MD＝－2.88，95%CI（－5.19，－0.56），P〈0.05]，腹泻发生率高于NG患者[OR＝1.66，95%CI（1.04，2.65），P〈0.05]，胃食管反流发生率低于NG患者[OR＝0.29，95%CI（0.12，0.66），P〈0.05]，胃潴留发生率低于NG患者[OR＝0.26，95%CI（0.14，0.41），P〈0.05]，管道脱落发生率低于NG患者[OR＝0.06，95%CI（0.01，0.46），P〈0.05]，肺炎发生率低于NG患者[OR＝0.59，95%CI（0.36，0.99），P〈0.05]。两者营养管留置时间、管道堵塞、腹部感染、急性肾功能不全、急性排斥反应发生率差异无统计学意义（P〉0.05）。结论肝移植术后PEG/PEJ置管患者营养管开始使用时间早、住院时间短，胃食管反流、胃潴留、管道脱落、肺炎发生率低，腹泻发生率较高。对于基础疾病严重、消化功能弱或合并消化系统障碍患者可以选择PEG/PEJ置管肠内营养，其余患者宜首选NG置管途径肠内营养。Objective To systematically review the effect of enteral nutrition via a naso-gastric （intestinal） tube （NG） vs a percutaneous endoscopic gastrostomy/jejunostomy （PEG/PEJ） after liver transplantation, and provide support for the selection of proper nutrition.Methods Pub Med, web of science, Cochrane Library （Jan, 2018）, CNKI, VIP and Wanfang Date were search until Jan, 2018. Two authors independently assessed the trials for inclusion and extracted the data. Discrepancies were resolved in consultation with a third reviewer, about the research of retrospective study for the effects of enteral nutrition via NG vs PEG/PEJ after liver transplantation was performed and supplemented. Publication bias were evaluated, and Meta-analyses were conducted with RevMan5.3.Results 4 studies were collected, involving 430 patients. The Meta-analysis showed that starting time of enteral nutrition of PEG/PEJ was earlier than NG （MD=-1.77, 95%CI -1.83 to -1.70, P〈0.05）. The average hospitalization time of PEG/PEJ was shorter than NG （MD=-2.88, 95%CI -5.19 to -0.56, P〈0.05）. The diarrhea incidence of PEG/PEJ was higher than NG （OR=1.66, 95%CI 1.04 to 2.65, P〈0.05）, and gastroesophageal reflux incidence of PEG/PEJ was lower than NG （OR=0.29, 95%CI 0.12 to 0.66, P〈0.05）. The gastric retention rate of PEG/PEJ was lower than NG （OR=0.26, 95%CI 0.14 to 0.41, P〈0.05）. Dislocation incidence of PEG/PEJ was lower than NG （OR=0.06, 95%CI 0.01 to 0.46, P〈0.05）. The pneumonia incidence of PEG/PEJ tube was lower than NG （OR=0.59, 95%CI 0.36 to 0.99, P〈0.05）. There were no significant differences between PEG/PEJ and NG on indwelling time, occlusion, abdominal infection, acute renal insufficiency, and acute rejection reaction.Conclusion PEG/PEJ had earlier starting time of enteral nutrition, shorter hospitalization time, lower nutrition tube placement related complications such as gastric esophagus reflux, gastric retention, dislocation rate and lower incidence of pneumonia, but the incidence

关 键 词：肝移植 肠内营养 鼻胃(肠)置管 经皮内镜下胃空肠造瘘置管 META分析 

分 类 号：R657.3[医药卫生—外科学]