剖宫产术后咀嚼口香糖促进肠道功能恢复的系统评价

Chewing Gum in Promoting Bowel Recovery after Cesarean Section:A Systematic Review

目的系统评价剖宫产术后咀嚼口香糖促进肠道功能恢复的有效效和安全性。方法计算机检索Cochrane Library、MEDLINE、EMbase和中国生物医学文献数据库,检索时间从建库至2010年,纳入比较剖宫产术后咀嚼口香糖与其他治疗方式促进肠道功能恢复的随机对照试验,在对纳入研究的偏倚风险进行评估后,采用RevMan 5.0.22软件进行Meta分析。结果共纳入3个随机对照试验,共745例患者。Meta分析结果显示:剖宫产术后咀嚼口香糖可以缩短患者术后首次肛门排气时间[MD=–6.54,95%CI(–7.82,–5.27),P<0.00001],减少术后肠梗阻的发生[RR=0.54,95%CI(0.34,0.87),P=0.01],可能缩短住院时间[MD=–0.21,95%CI(–0.39,–0.03),P=0.02]。目前尚缺乏足够的数据支持剖宫产术后咀嚼口香糖的安全性。结论剖宫产术后咀嚼口香糖可以促进患者术后胃肠功能恢复,减少术后肠梗阻的发生。但由于纳入研究数较少,方法学质量不高,因此尚需更多高质量研究以增加论证强度。

Objective To assess the efficacy and safety of chewing gum in promoting bowel recovery after cesarean section.Methods Such databases as The Cochrane Library,MEDLINE,EMbase and CBM were searched from their establishment to 2010 to include the randomized controlled trials（RCTs） of comparing chewing gum with other procedures for promoting postoperative bowel function after cesarean section.The risks of bias in the included studies were evaluated at randomization,allocation concealment,blinding,completeness of outcomes,and selective reporting.Meta-analyses were performed by RevMan 5.0.22 software.Results Three RCTs involving 745 participants were included.The results of meta-analyses showed chewing gum after cesarean section significantly shortened the time before getting the first postoperative flatus（MD= –6.54,95%CI –7.82 to –5.27,P0.000 01）,reduced the risks of postoperative ileus（RR=0.54,95%CI 0.34 to 0.87,P=0.01） and possibly shortened the length of hospital stay（MD= –0.21,95%CI –0.39 to –0.03,P=0.02） compared with blank control.Currently,no adequate data supported the safety of chewing gum after cesarean section.Conclusion Chewing gum after cesarean section can promote the postoperative bowel recovery,and reduce the odds of postoperative ileus.However,more high quality RCTs are required for lack of included studies and poor quality of methodology.