甲氧普胺提高鼻肠管幽门后置管成功率的Meta分析

Promotion of post-pyloric placement of naso-enteral feeding tubes by metoclopramide:a meta-analysis of randomly controlled trials

目的:通过Meta分析探讨甲氧氯普胺对鼻肠管幽门后置管成功率的影响。方法:计算机检索Cochrane Central Register of Controlled Trials,PubMed,EMBASE,OVID,Web of Science,中国知网,万方医学网。按纳入和排除标准进行文献筛选及资料提取。采用5.3版RevMan软件和STATA12.0软件进行Meta分析。结果:共纳入6篇文献,且这6篇研究间不存在异质性(χ~2=8.57;P=0.13;I2=42%),采用固定效应模型进行数据分析。结果显示,甲氧氯普胺可提高鼻肠管幽门后置管成功率,合并后的RR值为1.60(n=483;RR=1.60;95%CI:1.32~1.95),差异有显著性(P<0.000 1);与对照组对比,具体为鼻肠管置入十二指肠第一段、第二段、第三段后的患者所占比例均显示有显著性差异,高于对照组;置入空肠近端的患者所占比例虽高于对照组,但差异无显著性(RR=2.1;95%CI:0.9~4.8;P=0.075)。甲氧氯普胺组平均移行距离在置管24 h后测量为10.8 cm(95%CI:9.2~12.4;P=0.000 1),对照组平均移行距离为5.5 cm(95%CI:4.0~7.0;P=0.000 1),甲氧氯普胺组移行距离的组间差值均数为5.3 cm(95%CI:1.9~8.7;P<0.01),与对照组差异显著,明显高于对照组;6篇文献报道均未观察到不良反应。结论:甲氧氯普胺可提高鼻肠管幽门后置管成功率,但存在剂量差异。

OBJECTIVE To evaluate the effectiveness and safety of metoclopramide for post-pyloric placement of naso-enteral feeding tubes.METHODS Cochrane Central Register of Controlled Trials,PubMed,EMBASE,OVID,CNKI and Wangfang Data were searched from their inception to October 2015.Random controlled trials of metoclopramide in patients fed via naso-enteral feeding tubes were identified.Two assessors independently reviewed each trial.The Cochrane risk of bias assessment tool was used for quality assessment.RESULTS Six trials involving483 patients fed via naso-enteral feeding tubes were identified.Compared with placebo or no intervention,metoclopramide increased successful rate of post-pyloric placement（n=483,risk ratio（RR）1.60;95% CI：1.32 to 1.95;P〈0.000 1）.In one study reporting the exact location of the tube,including stomach,first（D1）,second（D2）,third（D3）and fourth（D4）portions of the duodenum,and proximal jejunum,the proportions of patients with post-D1,post-D2 and post-D3 placement in the metoclopramide group were higher than those in the control group.There was no difference in the proportion of patients with tubes migrated into proximal jejunum between the metoclopramide group and the control group（RR=2.1;95% CI：0.9 to 4.8;P=0.075）.Twenty-four hours after tube insertion,there was a 5.3 cm（95% CI：1.9 to 8.7）longer average migration distance in the metoclopramide group compared with the control group（P〈0.01）.Adverse effects were not reported.CONCLUSION This meta-analysis reveals that application of metoclopramide may promote success rate of post-pyloric placement in nutrition patients on the basis of present evidence.However,due to the poor methodological quality and high risk of bias,more high-quality studies with larger sample sizes are required.