不同肠内喂养方式对早产儿喂养不耐受效果的Meta分析

Meta-analysis of effects of different enteral feeding methods on feeding intolerance in preterm infants

[目的]系统评价持续鼻饲喂养和间歇鼻饲喂养对早产儿喂养不耐受的影响。[方法]计算机检索PubMed、Web of Science、EMbase、the Cochrane Library、EBSCO、CINAHL、中国生物医学文献数据库、中国知网、万方和维普中持续鼻饲喂养和间歇鼻饲喂养对早产儿喂养不耐受影响的随机对照试验,检索时间为建库至2018年10月31日。按照纳入及排除标准筛选文献,提取资料并评价纳入文献的方法学质量。采用RevMan 5.3软件对数据进行分析。[结果]共纳入17篇文献。Meta分析结果显示:持续鼻饲喂养早产儿喂养不耐受发生率低于间歇鼻饲喂养早产儿[RR=1.84,95%CI(1.51,2.24),P<0.00001],住院时间短于间歇鼻饲喂养早产儿[MD=1.80,95%CI(0.04,3.56),P=0.04],恢复至出生体重的时间短于间歇鼻饲喂养早产儿[MD=1.16,95%CI(0.21,2.12),P=0.02]。[结论]现有证据表明:持续鼻饲喂养与间歇鼻饲喂养相比,早产儿喂养不耐受发生率较低,恢复至出生体重的时间及住院时间缩短。但由于证据等级不高,且受到混杂因素影响,为保证新生儿生存质量,护理研究者需要在临床实践中进一步论证本研究结论。

Objective:To systematically evaluate effects of continuous nasogastric gavage and intermittent nasogastric gavage on feeding intolerance in preterm infants.Methods:Relevant randomized controlled trials on effects of continuous nasogastric gavage and intermittent nasogastric gavage on feeding intolerance in preterm infants were searched in following databases,such as PubMed,Web of Science,EMbase,the Cochrane Library,EBSCO,CINAHL,CBM,CNKI,WanFang Data and VIP from inception to 31th October,2018.Literatures were screened according to inclusion and exclusion criteria.After data extraction and methodology quality evaluation,Revman 5.3 software was used to take relevant analysis.Results:A total of 17 documents were included.Meta-analysis showed that incidence of feeding intolerance in preterm infants undergoing continuous nasogastric gavage was lower than that in preterm infants undergoing intermittent nasogastric gavage[RR=1.84,95%CI(1.51,2.24),P<0.00001].The hospitalization time in preterm infants undergoing continuous nasogastric gavage was shorter than that in preterm infants undergoing intermittent nasogastric gavage[MD=1.80,95%CI(0.04,3.56),P=0.04].And time of recovery to birth weight in preterm infants undergoing continuous nasogastric gavage was shorter than that in preterm infants undergoing intermittent nasogastric gavage[MD=1.16,95%CI(0.21,2.12),P=0.02].Conclusions:Current shows that compared with intermittent nasogastric gavage,incidence of feeding intolerance in preterm infants undergoing continuous nasogastric gavage is lower,time to regain birth weight and hospitalization time are also shorter.However,due to lower level of evidence and mixed factors,nursing researchers need to further demonstrate above conclusions in clinical practice,so as to provide a guarantee for the quality of life of newborns.