结直肠肿瘤择期手术后应用鼻胃管胃肠减压有效性与安全性的meta分析

Effectiveness and safety of nasogastric decompression after elective surgery for colon and rectum neoplasms: a meta-analysis

目的探讨结直肠肿瘤择期手术后应用鼻胃管胃肠减压的有效性和安全性。方法全面检索国内外公开发表的评价结直肠肿瘤择期手术后鼻胃管胃肠减压的随机对照试验(RCTs)文献,根据标准纳入文献,提取临床指标,进行meta分析。结果最终纳入6项RCTs(736例),大部分试验的病例组特征上具有可比性。非鼻胃管胃肠减压(non-NGD)组较鼻胃管胃肠减压(NGD)组胃肠功能恢复时间短[加权均数差WMD=-1.15,95%CI(-1.87～-0.43),P=0.002],住院时间少[WMD=-2.43,95%CI(-3.75～-1.10),P=0.000 3],虽呕吐发生多[RR=2.12,95%CI(1.19～3.78),P=0.01],但肺部感染发生少[RR=0.17,95%CI(0.03～0.95),P=0.04]。两组发生伤口感染[RR=0.76,95%CI(0.29～1.99),P=0.58]和鼻胃管再置[RR=1.85,95%CI(0.89～3.88),P=0.10]差异无统计学意义。结论结直肠肿瘤手术后不应用鼻胃管是安全的,常规应用鼻胃管并不能给患者带来更多益处,反而会增加并发症(如肺部感染)的发生。

Objective To evaluate the effectiveness and safety of nasogastric decompression after elective surgery for colon and rectum neoplasms.Methods A comprehensive search of Chinese and English-language medical literatures was performed to identify all published randomized controlled trials（RCTs） evaluating the nasogastric decompression after elective surgery for colon and rectum neoplasms.Selection of literatures was done according to the inclusion and exclusion criteria,and the clinical data were extracted from each trial to perform the meta-analysis.Results Six RCTs（736 patients） fulfilling the inclusion criteria were included in the present analysis,and most trials showed comparable characteristics in their patient groups at baseline.Patients in non-NGD group had a shorter recovery time of gastrointestinal function（WMD=-1.15,95%CI[-1.87——0.43],P=0.002）,shorter hospital stay（WMD=-2.43,95%CI[-3.75——1.10],P=0.000 3）,and less respiratory infection（RR=0.17,95%CI[0.03-0.95],P=0.04）,though more vomiting（RR=2.12,95%CI[1.19-3.78],P=0.01）.No significant differences were noted in wound infection（RR=0.76,95%CI[0.29-1.99],P=0.58）or nasogastric tube replacement（RR=1.85,95%CI[0.89-3.88],P=0.10）.Conclusion It is safe to give up NGD after elective surgery for colon and rectum neoplasms;routine use of NGD is not necessary because it does no more benefits to patients but increases the complications such as respiratory infection.