Lewis Stephen J, Andersen Henning K, Thomas Steve
Department of Gastroenterology, Derriford Hospital, Plymouth, Devon PL6 8DH, UK.
J Gastrointest Surg. 2009 Mar;13(3):569-75. doi: 10.1007/s11605-008-0592-x. Epub 2008 Jul 16.
We set out to evaluate early commencement of post-operative enteral nutrition versus traditional management in patients undergoing gastrointestinal surgery.
Electronic databases were searched, references lists were scanned and authors contacted for additional information. We looked for randomised controlled trials comparing early commencement of feeding (within 24 h) with no feeding in patients undergoing gastrointestinal surgery. Primary endpoints were wound infections, intra-abdominal abscesses, pneumonia, anastomotic leakage, mortality, length of hospital stay and complications of feeding. Data were combined to estimate the common relative risk of post-operative complications and associated 95% confidence intervals.
Thirteen trials, with a total of 1,173 patients, fulfilled our inclusion criteria. Mortality was reduced with early post-operative feeding. Early post-operative feeding increased vomiting. The direction of effect is suggestive of a reduction of risk of post-surgical complications and reduced length of hospital stay.
There is no obvious advantage in keeping patients 'nil by mouth' following gastrointestinal surgery. Early enteral nutrition is associated with reduced mortality, though the mechanism is not clear. This review supports the notion that early commencement of enteral feeding may be of benefit.
我们旨在评估胃肠道手术患者术后早期开始肠内营养与传统管理方法的效果。
检索电子数据库，查阅参考文献列表，并联系作者获取更多信息。我们查找了比较胃肠道手术患者早期开始喂养（24小时内）与不喂养的随机对照试验。主要终点包括伤口感染、腹腔内脓肿、肺炎、吻合口漏、死亡率、住院时间和喂养并发症。合并数据以估计术后并发症的常见相对风险及相关的95%置信区间。
13项试验，共1173例患者，符合我们的纳入标准。术后早期喂养可降低死亡率。术后早期喂养会增加呕吐。效应方向提示可降低术后并发症风险并缩短住院时间。
胃肠道手术后让患者“禁食”并无明显优势。早期肠内营养与降低死亡率相关，但其机制尚不清楚。本综述支持早期开始肠内喂养可能有益的观点。
