消化道肿瘤术后两种肠内营养途径应用效果的Meta分析

The application effect of two enteral nutrition pathways after gastrointestinal tumor surgery:a Meta-analysis

目的系统评价空肠造口与鼻肠管两种肠内营养(EN)途径用于消化道肿瘤术后患者的效果。方法计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方全文数据库、维普中文科技期刊数据库(VIP)、百度学术、Pub Med/MEDLINE、Web of Science、Cochrane Library各大数据库的随机对照试验研究(RCT),检索时间限制在2000年1月至2017年5月。由2名研究者采用Cochrane系统评价法独立进行文献质量评价和数据提取,比较两种EN途径对患者术后营养状况及相关并发症发生率的影响。采用Rev Man5.3软件进行Meta分析。结果最终纳入12篇随机对照研究,共842名患者。Meta分析结果显示:空肠造口组与鼻肠管组相比差异有统计学意义的是:白蛋白水平P<0.05;总蛋白水平P<0.05;导管脱位发生率P<0.05;恶心呕吐发生率P<0.000;肺部感染发生率P<0.01。两组相比差异无统计学意义的是:体质量P<0.05。结论消化道肿瘤患者术后经空肠造口行EN后营养状况较好,且并发症较少,应用较为安全,是更为合理的EN途径。

Objective To systematically evaluate the effect of two enteral nutrition（ EN） access route that nasointestinal tube and jejunostomy for patients with gastrointestinal tumor. Methods Literatures of randomized controlled trials were searched by retrieving CNKI,CBM,Wanfang datebase,VIP,Pubmed/MEDLINE and Cochrane Library,retrieval time limit from January 2000 to May2017. Two investigators used the Cochrane system evaluation method to evaluate the quality of literature and data extraction independently,and the effects of two EN access route on postoperative nutritional status and incidence of complications were compared. Meta analysis was performed by using Rev Man5. 3 statistical software. Results A total of nine randomized controlled trials involving 624 patients met inclusion criteria,including 248 cases of gastric cancer,278 cases of esophageal cancer,84 cases of pancreatic head cancer and 14 cases of colorectal cancer. The results of Meta analysis showed： there were statistically significant differences in the albumin level [WMD = 1. 07,95% CI（ 0. 28,1. 86）,P = 0. 008 ]; the total protein level [WMD = 2. 35,95% CI（ 0. 77,3. 92）,P = 0.003]; the incidence of nausea and vomiting [RR = 0. 17,95% CI（ 0. 07,0. 40）,P 〈 0. 0001]; the incidence of lung infection [RR= 0. 36,95% CI（ 0. 15,0. 85）,P = 0. 02]. There were no statistically significant differences in the body mass [WMD = 1. 24,95%CI（-0. 28,2. 76）,P = 0. 11]. Conclusion EN through jejunostomy is better for nutritional status of patients who suffer from the gastrointestinal tumor,and it brings less complications and is safer to use. Thus,jejunostomy is a more reasonable EN access route.