经皮胃造瘘术在脑卒中患者中应用有效性与安全性的Meta分析

Meta-analysis of the efficacy and safety of percutaneous gastrostomy in stroke patients

目的系统评价经皮内镜下胃造瘘(percutaneous endoscopic gastrostomy,PEG)与鼻胃管(nasogastric feeding,NGF)肠内营养在脑卒中患者中应用的有效性与安全性。方法计算机检索中、英文数据库,包括PubMed、EMbase、The Cochrane Library、万方数据库(Wangfang data)、中国知网(CNKI)、中国生物医学文献数据库(CBM),检索所有关于脑卒中患者经皮胃造瘘进行肠内营养的相关文献。由2名研究者根据纳排标准独立筛选文献、提取资料并对纳入研究进行质量评价后,采用RevMan5.3软件进行Meta分析。结果共纳入12篇文献,其中7篇为随机对照试验,5篇为非随机对照试验。Meta分析结果显示:在有效性方面,对于体重指数、血红蛋白、血清白蛋白、死亡率比较,差异无统计学意义;在安全性方面,PEG与NGF相比能够有效降低吸入性肺炎(RR=0.31,95%CI:0.18~0.53,P<0.01)、低蛋白血症(RR=0.34,95%CI:0.17~0.68,P=0.003)与水电解质紊乱(RR=0.24,95%CI:0.06~0.92,P=0.04)的发生率;对于腹胀、腹泻、消化道出血发生率的影响,差异无统计学意义。结论与NGF相比,PEG肠内营养能够有效降低脑卒中患者肺炎,降低感染风险;同时能够降低低蛋白血症、水电解质紊乱的发生率,改善患者不良结局。

Objective To systematically evaluate the efficacy and safety of enteral nutrition via percutaneous endoscopic gastrostomy(PEG)and nasogastric feeding(NGF)in stroke patients.Methods Databases including PubMed,EMbase,Cochrane Library,Wangfang database(Wangfang data),CNKI and CBM were searched for relevant literature about enteral nutrition via percutaneous gastrostomy in stroke patients.Literature screening,data extraction and quality evaluation of the included study were performed by two independent investigators.RevMan5.3 was used for data analysis.Results A total of 12 publications were included,of which 7 were randomized controlled trials(RCTs)and 5 were non-RCTs.There were no significant differences in BMI,hemoglobin,serum albumin and mortality.In terms of safety,PEG resulted in effective decreases in the incidence of pneumonia(RR=0.31,95%CI:0.18-0.53,P<0.01),hypoproteinemia(RR=0.34,95%CI:0.17-0.68,P=0.003)and fluid and electrolyte disorder(RR=0.24,95%CI:0.06-0.92,P=0.04)compared with NGF while there was no significant difference in the incidence of abdominal distension,diarrhea and gastrointestinal bleeding.Conclusion Compared with NGF,enteral nutrition with PEG can effectively reduce the incidence of pneumonia and the risk of infections in stroke patients and can also reduce the incidence of hypoproteinemia and fluid and electrolyte disorder,leading to improved patient outcomes.