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胃肠手术后肠内/肠外营养临床对照研究的荟萃分析

Enteral versus parenteral nutrition after gastrointestinal surgery: a meta-analysis of randomized controlled trials

摘要:

目的 分析国内外相关文献资料,比较肠内营养(EN)、肠外营养(PN)对胃肠手术患者预后的影响,探讨胃肠术后早期应用EN的合理性.方法 检索PubMed、EMBASE和Cochrane图书馆数据库,对1970年至2008年中胃肠手术后给予EN、PN相关的临床随机对照试验进行荟萃分析.评价终止的指标包括吻合口裂开、感染(包括导管脓毒症、伤口感染、肺炎、腹腔脓肿、泌尿系感染)、呕吐及腹胀、其他并发症、住院天数和病死率.结果 23组临床随机实验共2784例患者符合录入标准.与PN组比较,EN可减少吻合口裂开(RR=0.67,95%Cl:0.50~0.91;P=0.010)、感染(RR=0.72,95%CI:0.64~0.81;P<0.001),其他并发症(RR=0.82,95%CI:0.73~0.92;P<0.001)和住院的时间(加权均数差值=-3.60;95% CI:-3.88~-3.32;P<0.001).但EN组腹胀和呕吐的不良反应更多见(RR=1.39,95%CI:1.21~1.59;P<0.001).两组病死率比较差异无统计学意义(P=0.400).结论 胃肠手术后患者没有"禁食水"的必要,早期给予EN辅助治疗,有利于促进患者恢复,减少并发症的发生.

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abstracts:

Objective To compare the different prognosis between enteral nutrition (EN) and parenteral nutrition (PN) in patients after gastrointestinal surgery (GIS), and to investigate a reasonable regimen of entera] nutrition (EN) after GIS. Methods Randomized controlled trials (RCTs) on EN/PN after GIS from 1970 to 2008 retrieved from the data bank of Pubmed, EMBASE and Cochrane Library were analyzed. Evaluation endpoints were anastomotic dehiscence, infection (catheter sepsis, wound infection, pneumonia, intra-abdominal abscess and urinary tract infection), vomiting and abdominal distention, other complications, length of hospital stay and mortality rate. Results. Twenty-three RCTs including 2784 patients met the entering criteria. Compared with PN, EN was beneficial in the reduction of anastomotic dehiscence (RR =0. 67, 95% CI: 0. 50-0. 91 ; P = 0. 010), infections (RR = 0. 72, 95% CI: 0. 64-0. 81 ; P < 0.001), other complication (RR = 0. 82, 95 % CI: 0. 73-0. 92; P < 0. 001) and duration of hospital stay (weighted mean difference: -3.60; 95% CI: - 3. 88- - 3. 32; P <0.001). But the risk of vomiting was increased among patients with EN (RR = 1.39, 95% CI: 1.21-1.59; P < 0.001), and there was no significant differences in mortalities between the two groups (P = 0. 400). Conclusions There is no advantage in treating patients 'nil by mouth' after gastrointestinal surgery. It indicated that early commencement of enteral feeding is beneficial.

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