中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2009年
18期
1368-1373
,共6页
翁汉钦%何小玲%李富新%刘彤%王鹏志
翁漢欽%何小玲%李富新%劉彤%王鵬誌
옹한흠%하소령%리부신%류동%왕붕지
肠道营养%胃肠外营养%胃肠手术%荟萃分析
腸道營養%胃腸外營養%胃腸手術%薈萃分析
장도영양%위장외영양%위장수술%회췌분석
Enteral nutrition%Parenteral nutrition%Gastrointestinal surgery%Meta-analysis
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.
目的 分析國內外相關文獻資料,比較腸內營養(EN)、腸外營養(PN)對胃腸手術患者預後的影響,探討胃腸術後早期應用EN的閤理性.方法 檢索PubMed、EMBASE和Cochrane圖書館數據庫,對1970年至2008年中胃腸手術後給予EN、PN相關的臨床隨機對照試驗進行薈萃分析.評價終止的指標包括吻閤口裂開、感染(包括導管膿毒癥、傷口感染、肺炎、腹腔膿腫、泌尿繫感染)、嘔吐及腹脹、其他併髮癥、住院天數和病死率.結果 23組臨床隨機實驗共2784例患者符閤錄入標準.與PN組比較,EN可減少吻閤口裂開(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),其他併髮癥(RR=0.82,95%CI:0.73～0.92;P<0.001)和住院的時間(加權均數差值=-3.60;95% CI:-3.88～-3.32;P<0.001).但EN組腹脹和嘔吐的不良反應更多見(RR=1.39,95%CI:1.21～1.59;P<0.001).兩組病死率比較差異無統計學意義(P=0.400).結論 胃腸手術後患者沒有"禁食水"的必要,早期給予EN輔助治療,有利于促進患者恢複,減少併髮癥的髮生.
목적 분석국내외상관문헌자료,비교장내영양(EN)、장외영양(PN)대위장수술환자예후적영향,탐토위장술후조기응용EN적합이성.방법 검색PubMed、EMBASE화Cochrane도서관수거고,대1970년지2008년중위장수술후급여EN、PN상관적림상수궤대조시험진행회췌분석.평개종지적지표포괄문합구렬개、감염(포괄도관농독증、상구감염、폐염、복강농종、비뇨계감염)、구토급복창、기타병발증、주원천수화병사솔.결과 23조림상수궤실험공2784례환자부합록입표준.여PN조비교,EN가감소문합구렬개(RR=0.67,95%Cl:0.50～0.91;P=0.010)、감염(RR=0.72,95%CI:0.64～0.81;P<0.001),기타병발증(RR=0.82,95%CI:0.73～0.92;P<0.001)화주원적시간(가권균수차치=-3.60;95% CI:-3.88～-3.32;P<0.001).단EN조복창화구토적불량반응경다견(RR=1.39,95%CI:1.21～1.59;P<0.001).량조병사솔비교차이무통계학의의(P=0.400).결론 위장수술후환자몰유"금식수"적필요,조기급여EN보조치료,유리우촉진환자회복,감소병발증적발생.
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.
