肝胆手术患者选择性留置胃管可行性的Meta分析  

Feasibility of Selective Nasogastric Tube Indwelling in Patients With Hepatobiliary Surgery:A Meta-analysis

作　　者：甘婷 赵丽萍[2] 石莹 李欢[3] 乐梅先[4] Gan Ting;Zhao LiPing;Shi Ying;Li Huan;Yue MeiXian(Xiang Ya Nursing School,Central South University,Changsha 410000,Hunan Province,China;Department of Nursing,Second Xiangya Hospital of Central South University,Changsha 410011,Hunan Province,China;Pediatric Emergency Room,Second Xiangya Hospital of Central South University;Endoscope Room of Gastroenterology Department,Second Xiangya Hospital of Central South University)

机构地区：[1]中南大学湘雅护理学院,湖南长沙410000 [2]中南大学湘雅二医院护理部,湖南长沙410011 [3]中南大学湘雅二医院儿科急诊 [4]中南大学湘雅二医院消化内科内镜室

出　　处：《解放军护理杂志》2018年第6期8-14,共7页Nursing Journal of Chinese People's Liberation Army

摘　　要：目的探讨选择性留置胃管(即术前不留置胃管或术后早期拔管)对肝胆手术患者术后消化道并发症、呼吸道并发症及肛门排气时间的影响。方法检索PubMed、EMBASE、Web of Science、The Cochrane Library、中国期刊全文数据库(Chinese National Knowledge Infrastructure,CNKI)、中国生物医学文献数据库(Chinese Biology Medicine disc,CBMdisc)、万方数据库、维普中文期刊全文数据库等,收集术前不留置胃管或术后不同时间拔除胃管的随机对照研究(randomized controlled trial,RCT),用RevMan5.3软件进行统计分析,计算各效应量及其95%可信区间(confidence interval,CI)。结果共纳入文献11篇。与肛门排气后拔管相比,术前不留置胃管可降低患者术后呼吸道并发症的发生率(P<0.001)和胆囊(道)手术患者术后消化道并发症的发生率(P=0.02),且术前不留置胃管组患者术后肛门排气时间有所提前,但异质性较大(I^2=96%,P<0.001)。与肛门排气后拔管相比,术后早期(≤24h)拔管可降低患者术后消化道并发症发生率(P=0.007),但两组患者术后呼吸道并发症的发生率差异无统计学意义(P=0.24),两组患者术后肛门排气时间差异亦无统计学意义(P=0.97)。结论对于肝胆手术患者,选择性留置胃管(即术前不留置胃管或术后早期拔管)是可行的,但其最佳的胃管留置时间有待进一步研究。Objective To investigate the effects of selective nasogastric tube indwelling(including no gastric intubation before surgery and early extubation after surgery)on postoperative digestive complications,respiratory complications and time to anal exhaust after surgery among patients undergoing hepatobiliary operation.Methods Randomized controlled trials of no gastric intubation before surgery and removal of indwelling gastric tube at different time were collected in databases such as PubMed,EMBASE,Web of Science,The Cochrane library,Chinese national knowledge infrastructure(CNKI),Chinese biomedical literature database(CBM),Wanfang database,VIP and Superstar discovery system.Data were analyzed by RevMan 5.3 version.The effect size and the 95%CI were calculated.Results Eleven RCTs were included.Compared with extubation after anal exhaust,no indwelling gastric tube before surgery can reduce the incidence of respiratory complications(P<0.001),and it can also reduce the incidence of digestive complications among patients undergoing biliary surgery or gallbladder surgery(P=0.02).The time to anal exaust after surgery was shorter in the group of no indwelling gastric tube,however the heterogeneity was great(I 2=96%,P<0.001).Between early postoperative extubation group(less than 24 hours)and extubation after anal exhaust group,the former has a lower incidence of digestive complications(P=0.007).There was no significant difference on the incidence of respiratory complications(P=0.24)or the time to anal exhaust(P=0.97)between two gruops.Conclusion For patients undergoing hepatobiliary surgery,selective nasogastric tube is feasible,but the most suitable time of gastric tube indwelling remains to be further studied.

关 键 词：肝胆手术 留置胃管 选择性 META分析 

分 类 号：R472.4[医药卫生—护理学]