腹部手术患者围术期进行膳食纤维补充对术后胃肠道不良反应的系统评价及Meta分析  

Impact of perioperative dietary fiber intake on gastrointestinal adverse events in adults undergoing abdominal surgery:A systematic review and meta-analysis

作　　者：王思思 王婷文 黄著瑛 浦东 胡婧文 顿文亮[1] Si-Si Wang;Ting-Wen Wang;Zhu-Ying Huang;Dong Pu;Jing-Wen Hu;Wen-Liang Dun(Department of Pharmacy,Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Nanjing 210003,Jiangsu Province,China,Medicine and Clinical Pharmacy,China Pharmaceutical University,Nanjing 211198,Jiangsu Province,China;Guangxi Key Laboratory of Special Biomedicine;School of Medicine,Guangxi University,Nanning 530004,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]南京中医药大学附属南京中医院药学部,江苏省南京市210003 [2]中国药科大学基础医学与临床药学学院,江苏省南京市211198 [3]广西特色生物医药重点实验室,广西大学医学院,广西壮族自治区南宁市530004

出　　处：《世界华人消化杂志》2025年第3期235-244,共10页World Chinese Journal of Digestology

基　　金：江苏省药品监管科学科研项目,No.202384;第六批南京市老中医药专家学术经验继承项目,No.2024NJLPSC-DWL.

摘　　要：背景腹部手术后患者常出现胃肠道不良反应,影响术后恢复.膳食纤维在调节胃肠功能方面具有潜在作用,但其在围术期的应用效果尚不明确.因此,系统评价膳食纤维对腹部手术患者术后胃肠道功能的影响具有重要意义.目的本研究旨在评估围术期使用含膳食纤维的肠内营养对腹部手术患者术后胃肠道不良事件的效果.方法检索PubMed、The Cochrane Library、Embase数据库,时限为从2000-01/2023-05,根据纳排标准筛选文献后提取数据,用Cochrane偏倚风险评价工具进行文献质量评价,使用RevMan5.4和Stata 12.0进行统计分析.结果共纳入9项随机对照试验(randomized controlled trial,RCT),涉及833例患者.其中6项RCT用于膳食纤维补充对术后腹腔感染的Meta分析,有5项RCT用于术后腹泻的Meta分析,5项RCT用于术后首次排气时间的Meta分析,结果显示膳食纤维补充能减少腹腔感染[危险度比(risk ratio,RR)=0.46;95%置信区间(confidence interval,CI):0.26-0.80;P=0.006],腹泻(RR=0.48;95%CI:0.32-0.71;P=0.0003)的发生风险,并且促进术后胃肠道功能恢复,缩短排气排便时间(MD=-0.16;95%CI:-0.24至-0.09;P<0.001).而对于腹部手术患者而言,膳食纤维补充没有减少术后肠梗阻,吻合口瘘及恶心呕吐的发生风险(P>0.05).结论腹部手术患者可使用富含膳食纤维的肠内营养,降低术后腹腔感染及腹泻的发生风险,促进胃肠道功能恢复,并且不会增加恶心、呕吐等喂养不耐受的情况.BACKGROUND Patients undergoing abdominal surgery often experience gastrointestinal adverse reactions,which can hinder postoperative recovery.Dietary fiber has potential benefits in regulating gastrointestinal function,but its effectiveness during the perioperative period remains unclear.Therefore,a systematic evaluation of the impact of dietary fiber on postoperative gastrointestinal function in abdominal surgery patients is of significant importance.AIM To assess the effects of perioperative dietary fiber-enriched enteral nutrition on postoperative gastrointestinal adverse events in patients undergoing abdominal surgery.METHODS Articles published between January 2000 and May 2023 were searched.The occurrence of postoperative gastrointestinal adverse reactions(abdominal infection,intestinal obstruction,diarrhea,nausea and vomiting,anastomotic leak,and time to first flatus)were used as outcomes for systematic review.RESULTS A total of 9 randomized controlled trials reporting 833 participants were included.Using meta-analysis,the results showed that perioperative dietary fiber supplement was associated with a lower abdominal infection incidence[risk ratio(RR)=0.46;95%confidence interval(CI):0.26-0.80,P=0.006]and lower diarrhea incidence(RR=0.48;95%CI:0.32-0.71,P<0.001),promoted postoperative gastrointestinal function recovery,and shortened the time to first flatus[mean difference(MD)=-0.16;95%CI:-0.24 to-0.09,P<0.001].However,dietary fiber supplementation did not reduce the risk of postoperative intestinal obstruction,nausea and vomiting,or anastomotic leak(P>0.05).CONCLUSION Dietary fiber-rich enteral nutrition can reduce the risk of postoperative abdominal infections and diarrhea,and promote recovery of gastrointestinal function in patients undergoing abdominal surgery,without increasing feeding intolerance such as nausea and vomiting.

关 键 词：膳食纤维 腹部手术 腹腔感染 胃肠道不良反应 

分 类 号：R73[医药卫生—肿瘤]