间歇经口管饲在脑卒中吞咽障碍患者中应用的Meta分析

Meta analysis of intermittent oral feeding application in patients with swallowing disorders after stroke

目的评价间歇经口至食管或胃管管饲(间歇管饲)在脑卒中吞咽障碍患者的吞咽功能、营养状况、吸入性肺炎、生活质量、日常生活活动能力(ADL)中的应用效果。方法计算机检索PubMed、Web of Science、Cochrane Library、CINAHL、MEDLINE、中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文献数据库(CBM)、百度学术等数据库中关于间歇管饲在脑卒中吞咽障碍患者中应用的随机对照试验,检索时限为建库至2021年12月31日。由2名研究员独立进行文献的检索、筛选、质量评价和数据提取,采用Revman 5.4软件对纳入的文献进行Meta分析。结果最终纳入文献22篇,其中中文21篇,英文1篇,总样本量为1765例。Meta分析结果显示,间歇管饲组在改善吞咽功能(MD=-1.15,95%CI:-1.33~-0.96,P<0.01)、吞咽障碍疗效(RR=1.31,95%CI:1.22~1.40,P<0.01);提高血红蛋白含量(MD=4.70,95%CI:3.05~6.34,P<0.01)、血清白蛋白含量(MD=2.16,95%CI:1.35~2.96,P<0.01)、血清前白蛋白含量(MD=21.36,95%CI:14.16~28.56,P<0.01)、血清总蛋白含量(MD=3.07,95%CI:1.82~4.31,P<0.01)、体质指数(MD=2.30,95%CI:1.79~2.81,P<0.01)、肱三头肌皮褶厚度(MD=1.53,95%CI:0.83~2.23,P<0.01);降低吸入性肺炎发生率(RR=0.33,95%CI:0.24~0.45,P<0.01);提高患者的生活质量(MD=21.67,95%CI:18.76~24.59,P<0.01)和日常生活活动能力能力(MD=7.78,95%CI:4.96~10.60,P<0.01)方面均优于留置胃管组,差异具有统计学意义。结论间歇管饲可以改善脑卒中吞咽障碍患者的吞咽功能和营养状况、提高患者的生活质量和日常生活活动能力、降低肺炎的发生率,具有良好的临床效果。

Objective To evaluate the application effect of intermittent oral to esophageal or gastric tube feeding(intermittent tube feeding)on swallowing function,nutritional status,aspiration pneumonia,quality of life,and activity of daily living(ADL)in stroke patients with swallowing disorders.Methods Computer search was conducted on PubMed,Web of Science,Cochrane Library,CINAHL,MEDLINE,China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database,China Biomedical Literature Database(CBM),Baidu Academic and other databases for randomized controlled trials on the application of intermittent tube feeding in patients with swallowing disorders in stroke.The search was conducted until December 31,2021.Two researchers independently conducted literature search,screening,quality evaluation,and data extraction,and used Revman 5.4 software to conduct Meta analysis of the included literature.Results Ultimately included 22 articles,including 21 in Chinese and 1 in English,with a total sample size is 1765.The Meta analysis results showed that the intermittent tube feeding group improved swallowing function(MD=-1.15,95%CI:-1.33~0.96,P<0.01)and swallowing disorders(RR=1.31,95%CI:1.22~1.40,P<0.01);Increase hemoglobin content(MD=4.70,95%CI:3.05~6.34,P<0.01),serum albumin content(MD=2.16,95%CI:1.35~2.96,P<0.01),serum prealbumin content(MD=21.36,95%CI:14.16~28.56,P<0.01),serum total protein content(MD=3.07,95%CI:1.82~4.31,P<0.01),body mass index(MD=2.30,95%CI:1.79~2.81,P<0.01),triceps brachii skinfold thickness(MD=1.53,95%CI:0.83~2.23,P<0.01);Reduce the incidence of aspiration pneumonia(RR=0.33,95%CI:0.24~0.45,P<0.01);The improvement of patients'quality of life(MD=21.67,95%CI:18.76~24.59,P<0.01)and activities of daily living(MD=7.78,95%CI:4.96~10.60,P<0.01)were superior to the indwelling gastric tube group,with statistically signifi cant differences.Conclusion Intermittent tube feeding can improve the swallowing function and nutritional status of stroke patients with swallowing disorders,improve their quality of life and activities of daily life,reduce the incidence of pneumonia,and have good clinical effects.