对早产儿经幽门管喂养与胃管喂养的系统评价。
Systematic review of transpyloric versus gastric tube feeding for preterm infants.
作者信息
McGuire W, McEwan P
机构信息
Tayside Institute of Child Health, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2004 May;89(3):F245-8. doi: 10.1136/adc.2002.022459.
AIM
To determine if enteral tube feeding by the transpyloric versus the gastric route improves feeding tolerance, and growth and development, without increasing adverse events, in preterm infants.
METHODS
Systematic review of randomised controlled trials. A search was made of the Cochrane Controlled Trials Register (CCTR; 2003, issue 1), Medline (1966 to April 2003), and Embase (1980 to April 2003), and references in previous reviews. The data were extracted, analysed, and synthesised using the standard methods of the Cochrane Neonatal Collaborative Review Group.
RESULTS
Data were found from eight trials. No evidence of an effect on growth or development was found, but transpyloric feeding was associated with a greater incidence of gastrointestinal disturbance: relative risk (RR) 1.45, 95% confidence interval (CI) 1.05 to 2.09. Transpyloric feeding was also associated with increased mortality: RR 2.46, 95% CI 1.36 to 4.46. However, the trial that contributed most to this finding may have been affected by allocation bias. No significant differences were detected in the incidence of other adverse events, including necrotising enterocolitis, intestinal perforation, and aspiration pneumonia.
CONCLUSIONS
No evidence of benefit was found, but evidence of harm was found. Feeding by the transpyloric route cannot be recommended for preterm infants.
目的
确定经幽门管饲与经胃管饲相比，是否能提高早产儿的喂养耐受性、促进生长发育，且不增加不良事件的发生。
方法
对随机对照试验进行系统评价。检索了Cochrane对照试验注册库（CCTR；2003年第1期）、Medline（1966年至2003年4月）和Embase（1980年至2003年4月）以及以往综述中的参考文献。采用Cochrane新生儿协作综述组的标准方法提取、分析和综合数据。
结果
从八项试验中获取了数据。未发现对生长或发育有影响的证据，但经幽门管饲与胃肠道紊乱发生率较高相关：相对危险度（RR）为1.45，95%置信区间（CI）为1.05至2.09。经幽门管饲还与死亡率增加相关：RR为2.46，95%CI为1.36至4.46。然而，对这一结果贡献最大的试验可能受到了分配偏倚的影响。在包括坏死性小肠结肠炎、肠穿孔和吸入性肺炎在内的其他不良事件发生率方面未检测到显著差异。
结论
未发现有益证据，但发现了有害证据。不建议对早产儿采用经幽门管饲。
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