间歇性经口至食管管饲法在脑卒中后吞咽障碍患者中应用的Meta分析

Meta-analysis of the effects of intermittent oro-esophageal tube feeding in patients with dysphagia after stroke

目的探讨间歇性经口至食管管饲法(IOE)对脑卒中后吞咽障碍患者的吞咽功能、吸入性肺炎发生率、营养状况等的影响。方法计算机检索PubMed、Embase、Web of Science、EBSCO、Elsevier、OVID、ProQuest、CNKI、维普中文科技期刊全文数据库和万方数据库中的RCT。检索时限为建库至2020年10月1日。由2名研究员根据Cochrane 5.11系统评价方法独立进行文献检索、筛选、资料提取和质量评价,采用RevMan 5.3软件对纳入文献进行Meta分析。结果共纳入21篇文献,总样本量为1616例,其中IOE患者809例,经鼻留置胃管患者807例。Meta分析结果显示,IOE能增强患者吞咽功能(RR=1.31,95%CI:1.21~1.43,P<0.01),降低吸入性肺炎发生率(RR=0.43,95%CI:0.28~0.65,P<0.01),提高血红蛋白量(MD=6.73,95%CI:5.89~7.57,P<0.01)、血清总蛋白量(MD=4.44,95%CI:3.69~5.20,P<0.01)、血清前白蛋白量(MD=17.45,95%CI:7.29~27.62,P<0.01)、血清白蛋白量(MD=1.72,95%CI:1.33~2.10,P<0.01)。结论IOE能提高脑卒中后吞咽障碍患者的吞咽功能,降低吸入性肺炎发生率,提高营养水平,具有积极的临床实践价值。

Objective To explore the effects of intermittent oro-esophageal tube feeding(IOE)on the swallowing function,incidence of aspiration pneumonia,and nutritional status in patients with dysphagia after stroke.Methods Randomized controlled trials(RCTs)published from the establishment of the database to October 1,2020 were retrieved from PubMed,Embase,Web of Science,EBSCO,Elsevier,OVID,ProQuest,CNKI,VIP,and Wanfang database.Two researchers independently conducted literature search,screening,data extraction and quality evaluation based on systematic reviews using Cochrane 5.11.RevMan 5.3 was used for the Meta-analysis of the included literature.Results A total of 21 articles were included,with a total sample size of 1616,including 809 patients receiving IOE and 807 patients with nasal indwelling gastric tube feeding.The Meta-analysis showed that IOE could enhance the swallowing function of patients(RR=1.31,95%CI:1.21-1.43,P<0.01),reduce the incidence of aspiration pneumonia(RR=0.43,95%CI:0.28-0.65,P<0.01),increase hemoglobin content(MD=6.73,95%CI:5.89-7.57,P<0.01),serum total protein content(MD=4.44,95%CI:3.69-5.20,P<0.01),serum prealbumin content(MD=17.45,95%CI:7.29-27.62,P<0.01),and serum albumin content(MD=1.72,95%CI:1.33-2.10,P<0.01).Conclusions IOE can improve the swallowing function,reduce the incidence of aspiration pneumonia,and improve the nutritional level of patients with dysphagia after stroke,which has positive significance in clinical practice.