鼻饲大黄预防危重病患者胃肠功能衰竭研究的Meta分析

Meta-analysis of Studies on the Prevention of Gastrointestinal Failure of Critical Diseases by Rhubarb Feeding

目的评价大黄鼻饲对预防危重病患者胃肠功能衰竭的疗效和研究可靠性。方法按照纳入和排除标准检索和筛查文献。所纳入文献中干预措施对主要结局指标如胃肠黏膜出血发病率、肠麻痹发病率、胃肠衰竭持续时间,和次要结局指标如多器官功能衰竭(MODS)的发病率、MODS的病死率的结果进行Meta分析。结果共纳入文献8篇,全部为中文文献。Meta分析结果显示:鼻饲大黄组胃肠黏膜出血的发生的相对风险为0.42(95%CI 0.33~0.52),肠麻痹的发生风险为0.45(95%CI 0.34~0.58),胃肠功能衰竭持续时间的合并效应量加权均数差(WMD)-3.30(95%CI-3.81^-2.78)。MODS的发生相对风险为0.46(95%CI 0.37~0.57)。MODS的死亡风险0.59(95%CI 0.29~1.19)。结论鼻饲大黄可预防危重病患者胃肠黏膜疾病,减少出血风险,并能降低发生肠麻痹风险。鼻饲大黄预防组患者在发生胃肠功能衰竭后继续给予大黄治疗,比发生胃肠功能衰竭后给予相同治疗的对照组胃肠功能衰竭持续时间缩短。给予大黄鼻饲可降低MODS的风险,但不能降低MODS的死亡风险。

Objective： To evaluate the effect and the reliability of the prevention of gastrointestinal failure of critically ill patients by rhubarb feeding. Methods： The literature was retrieved and screened according to the in- clusion and exclusion criteria. Then,as to the preventions mentioned in the inclusive literature,a Meta-analysis was performed on their major outcomes,including the incidence of hemorrhage of gastrointestinal mucosa, the in- cidence of intestinal paralysis, and the duration of gastrointestinal failure of the critically ill patients, and their mi- nor outcomes,as well as the incidence and the mortality rate of MODS. Results： A total of eight documents, which were all Chinese documents,were included. The findings of Meta-analysis showed that,in the group of rhubarb feeding,the relative occurrence risk of hemorrhage of gastrointestinal mucosa was 0.42 （95%CI 0.33- 0.52） ,and the risk of intestinal paralysis was 0.45 （95%CI 0.34-0.58）. The weighted mean difference （WMD） of combined effect size of the duration of gastrointestinal failure was -3.30 （95%CI -3.81^-2.78）. The relative oc- currence risk of MODS was 0.46 （95%CI 0.37-0.57）,and the mortality risk of MODS was 0.59 （95%CI 0.29- 1.19）. Conclusion： Gastrointestinal mucosal diseases of critically ill patients can be prevented and their risks of hemorrhage and intestinal paralysis can be reduced by rhubarb feeding before their gastrointestinal failure. The critically ill patients are fed with rhubarb as a preventive measure before the gastrointestinal failure, and they are still treated with rhubarb after the gastrointestinal failure. The duration of gastrointestinal failure of the rhubarb feeding group is !shorter than that of the normal control group with the same treatment after the gastrointestinal failure. Rhubarb feeding can reduce the risk of multiple organ dysfunction syndrome （MODS） ,but fail to reduce the mortality risks of MODS.