四种不同体位对早产儿胃排空影响的网状Meta分析

Effect of four different positions on gastric emptying in preterm infants:A network Meta-analysis

目的评价不同体位对早产儿胃排空的影响,为早产儿喂养后的体位管理提供循证依据。方法计算机检索Cochrane Library、Web of Science、PubMed数据库、MEDLINE(Ovid平台)、Central(Ovid平台)、Embase(Ovid平台)、中国生物医学文献数据库(CBM)、万方和中国知网(CNKI)等数据库中关于不同体位对早产儿胃排空影响的随机对照试验(RCT)及队列研究。由2名研究者根据纳入和排除标准独立检索、筛选文献、提取资料与文献质量评价后,采用RevMan 5.3和ADDIS v 1.16.6软件进行直接比较Meta分析及网状Meta分析,同时绘制网状关系图。结果最终纳入15篇文献,其中英文文献9篇,中文文献6篇,总样本1764例。网状Meta分析采用一致性模型分析显示:仰卧位与俯卧位[SMD=5.62,95%CI(0.46,10.86)]、俯卧位与左侧卧位[SMD=-9.43,95%CI(-15.87,-3.12)]、仰卧位与右侧卧位[SMD=7.02,95%CI(0.74,13.48)]及左侧卧位与右侧卧位[SMD=10.90,95%CI(4.24,17.41)]在影响早产儿胃排空方面,差异有统计学意义(P<0.05);而仰卧位与左侧卧位[SMD=-3.86,95%CI(-10.44,2.88)]及右侧卧位与俯卧位[SMD=-1.41,95%CI(-7.46,4.50)]比较,差异无统计学意义(P>0.05)。累计排序概率曲线下面积排序结果为右侧卧位对促进胃排空的效果最佳,俯卧位次之。节点分析结果显示,直接比较与间接比较结果一致(P>0.05)。结论4种不同体位中,右侧卧位和俯卧位对促进早产儿胃排空的效果较好,但仍需更多高质量且多中心大样本随机对照试验进行进一步验证。

Objective To evaluate the effect of different body positions on gastric emptying in preterm infants,and to provide evidence for postural management after feeding.Methods Search Cochrane Library,Web of Science,Pubmed,MEDLINE(Ovid),Central(Ovid),Embase(Ovid),SinoMed,Wanfang Database,CNKI and manual search.A randomized controlled trial study and Cohort studies were conducted to compare the effects of different body positions on gastric emptying in preterm infants.After literature screening,literature quality evaluation and data extraction,we used review manager and ADDIS to do direct comparison Meta-analysis and net-work Meta-analysis,at the same time,Draw Mesh relationship map.Results A total of 1764 subjects were enrolled in this study,including 9 English and 6 Chinese literatures.The consistency model showed that supine position VS prone position[SMD=5.62,95%CI:(0.46,10.86)],prone position VS left lateral position[SMD=-9.43,95%CI:(-15.87,-3.12)],supine position VS right lateral position[SMD=7.02,95%CI:(0.74,13.48)],left VS right lateral position[SMD=10.90,95%CI:(4.24,17.41)]had significant difference in the effect of gastric emptying in preterm infants(P<0.05),supine VS left decubitus position[SMD=-3.86,95%CI:(-10.44,2.88)],right lateral position VS prone position[SMD=-1.41,95%CI:(-7.46,4.50)]had no significant difference(P>0.05).The results of area ranking under cumulative ranking probability curve showed that right lateral decubitus position had the best effect on gastric emptying,followed by prone position.The results of node analysis showed that the direct comparison was consistent with the indirect comparison(P>0.05).Conclusion Right lateral position and prone position are effective in improving gastric emptying in preterm infants,but more high quality,multi-center and large sample randomized controlled trial are needed.