鼻空肠管和鼻胃管在ICU危重病人中应用效果的Meta分析

Efficacy of the application of Nasojejunal Feeding and Nasogastric Feeding in critically ill ICU patients:Meta-analysis and systematic review

[目的]评价经鼻空肠管喂养(NJF)和经鼻胃管喂养(NGF)两种营养方式在ICU危重病人中的应用效果。[方法]检索PubMed、EMbase、Cochrane Library、万方数据库、中国知网全文数据库(CNKI)和维普全文数据库(VIP),检索关于ICU危重症病人应用NJF和NGF的临床随机对照试验。采用Revman 5.3软件对检索到的文献进行Meta分析。[结果]纳入22篇文献,共1 498例病人。Meta分析结果显示:营养到达所需时间[WMD=-84.84,95%CI(-95.19,-74.49),P<0.000 01]、胃潴留发生率[RR=0.16,95%CI(0.09,0.29),P<0.000 01]、反流误吸发生率[RR=0.18,95%CI(0.10,0.32),P<0.000 01]、吸入性肺炎发生率[RR=0.44,95%CI(0.28,0.70),P=0.000 5]、ICU监护时间[WMD=-2.69,95%CI(-4.24,-1.13),P=0.000 7]低于NGF组,但其消化道出血发生率[RR=2.26,95%CI(1.10,4.65),P=0.03]高于NGF组。[结论]ICU危重症病人采取经NJF喂养可提高营养摄入效率,减少多种并发症,但易导致消化道出血,仍需更多高质量、大样本研究进一步证实。

Objective：To evaluate the application effect of nasojejunal feeding and nasogastric feeding for critically ill ICU patients.Methods：The randomized controlled trials（RCTs） related to nasojejunal feeding and nasogastric feeding in ICU patients were collected from PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure（CNKI）,Wanfang Database and China full-text database（VIP）.Meta-analysis was conducted for these literatures by using the software RevMan 5.3.Results：22 articles were involved totally 1 498 patients are included.The Meta-analysis showed that time to reach the required nutrition[WMD=-84.84,95%CI（-95.19,-74.49）,P〈0.000 01],incidence of gastric retention[RR=0.16,95%CI（0.09,0.29）,P〈0.000 01],the incidence of reflux and aspiration[RR=0.18,95%CI（0.10,0.32）,P〈0.000 01],the incidence of aspiration pneumonitis[RR=0.44,95%CI（0.28,0.70）,P=0.000 5],and length of ICU stay lower that in NGF group[WMD=-2.69,95%CI（-4.24,-1.13）,P=0.000 7],but NJF increased the rates of gastrointestinal bleeding[RR=2.26,95%CI（1.10,4.65）,P=0.03].Conclusions：Nasojejunal feeding in critically ill ICU patients could increase the efficiency of nutrition intake and reduce the complications.But it easily lead to gastrointestinal bleeding,still need more high-quality,large sample study further confirmed.