改良胃管置入长度测量方法对新生儿鼻饲效果影响的Meta分析

Effect of modified measurement of gastric tube placement length on neonatal nasal feeding: a meta-analysis

[目的]系统评价改良胃管置入长度测量方法在新生儿鼻饲中的应用效果。[方法]计算机检索中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库、Cochrane Library、PubMed、Web of Science数据库有关改良胃管置入长度测量方法对新生儿鼻饲效果的随机对照试验(RCT),检索范围均为建库至2018年1月。由两名研究者根据Cochrane系统评价方法对纳入文献进行质量评价和资料提取,采用RevMan 5.0软件进行Meta分析。[结果]共纳入8篇文献、9项研究,涉及1 052例病人。Meta分析结果显示:新生儿改良胃管置入长度测量方法可提高胃管置管成功率[OR=5.55,95%CI(3.64,8.48),P<0.000 01],降低胃食管反流率[OR=0.24,95%CI(0.13,0.43),P<0.000 01]、恶心呕吐发生率[OR=0.27,95%CI(0.14,0.52),P<0.000 1]、腹胀发生率[OR=0.29,95%CI(0.12,0.70),P=0.006]和胃出血发生率[OR=0.22,95%CI(0.07,0.68),P=0.009],但在吸入性肺炎发生率方面两组无明显差异[OR=0.41,95%CI(0.10,1.64),P=0.21]。[结论]新生儿改良胃管置入长度测量方法可替代传统胃管置入长度测量方法,具有安全可行性。但受纳入研究的质量和数量的限制,对该Meta分析结果保持谨慎态度,期待临床开展更多大样本、高质量的随机对照试验予以论证。

Objective: To evaluate the application of modified gastric tube placement length measurement in neonatal nasal feeding. Methods: Literatures of randomized controlled trials (RCT) on improving the effect of gastric tube placement length measurement on neonatal nasal feeding were retrieved from the Chinese biomedical literature database(CBM),China Journal Full-text Database (CNKI),Wanfang database,Cochrane Library,PubMed and Web of Science database,from the built to January 2018.The quality of the included literatures were evaluated and data were extracted by two researchers,according to the Cochrane systematic review method.And meta-analysis was performed by using RevMan 5.0 software. Results: A total of 8 articles and 9 studies were included,involving 1 052 patients.Meta-analysis results had showed that neonatal modified gastric tube placement length measurement method could improve the success rate of gastric tube placement [OR=5.55,95% CI (3.64,8.48),P <0.000 01];reduce the gastroesophageal reflux rate [OR=0.24,95% CI (0.13,0.43), P< 0.000 01],incidence rate of nausea and vomiting [OR=0.27,95% CI (0.14,0.52), P <0.000 1],incidence rate of abdominal distension [OR=0.29,95% CI (0.12,0.70), P =0.006],and incidence of rate gastric bleeding [OR=0.22,95% CI (0.07,0.68), P =0.009].However,there was no significant difference in the incidence rate of aspiration pneumonia[OR=0.41,95% CI (0.10,1.64), P =0.21]. Conclusions: The modified gastric tube placement length measurement in neonatal nasal feeding could replace the traditional measuring method,which was safe and feasible.However,due to the limitations of quality and quantity of the included studies,the results of the meta-analysis should be regarded with caution.More large-scale,high-quality RCTs were expected in clinical trials in the future.