Silva Cristiane Costa Reis da, Bennett Cathy, Saconato Humberto, Atallah Álvaro N
Joaquim Calado 120, Federação, Salvador, Bahia, 40230093, Brazil.
Cochrane Database Syst Rev. 2015 Jan 7;1(1):CD003353. doi: 10.1002/14651858.CD003353.pub2.
Enteral nutrition by feeding tube is a common and efficient method of providing nutritional support to prevent malnutrition in hospitalised patients who have adequate gastrointestinal function but who are unable to eat. Gastric feeding may be associated with higher rates of food aspiration and pneumonia than post-pyloric naso-enteral tubes. Thus, enteral feeding tubes are placed directly into the small intestine rather than the stomach, and the use of metoclopramide, a prokinetic agent, has been recommended to achieve post-pyloric placement, but its efficacy is controversial. Moreover, metoclopramide may include adverse reactions, which with high doses or prolonged use may be serious and irreversible.
To determine the effect of intravenous metoclopramide on post-pyloric placement of the naso-enteral tube in adults.
Trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10) which includes the CUGPD group's specialised register of trials, MEDLINE (1996 to 21 October 2014), EMBASE (1988 to 21 October 2014), LILACS (2005 to 21 October 2014) We did not confine our search to English language publications. Searches in all databases were updated originally in January 2005, then in November 2008 and again in October 2014. No new studies were found in 2008 or in 2014.
We selected randomised controlled trials of adults needing enteral nutrition, who received intravenous or intramuscular metoclopramide to aid placement of transpyloric naso-enteral feeding tubes, compared to placebo or no intervention.
We used standard methodological procedures expected by The Cochrane Collaboration. All analyses were performed according to the intention-to-treat method. We present risk ratios (RR) with 95% confidence intervals (CI).
Four studies, with a total of 204 participants were included and analysed. The trials compared metoclopramide with placebo (two trials) or with no intervention (two trials). Metoclopramide was investigated at doses of 10 mg (two trials) and 20 mg (two trials). There was no statistically significant difference between metoclopramide versus placebo or no intervention administered to promote tube placement (RR 0.82, 95% CI 0.61 to 1.10). Metoclopramide at doses of 10 mg (RR 0.82, 95% CI 0.60 to 1.11) and 20 mg (RR 0.62, 95% CI 0.15 to 2.62) were equally ineffective in facilitating post-pyloric intubation when compared with placebo or no intervention.
AUTHORS' CONCLUSIONS: In this review, we found only four studies that fitted our inclusion criteria. These were small, underpowered studies, in which metoclopramide was given at doses of 10 mg and 20 mg. Our analysis showed that metoclopramide did not assist post-pyloric placement of naso-enteral feeding tubes.Ideally randomised clinical trials should be performed that have a significant sample size, administering metoclopramide against control, however, given the lack of efficacy revealed by this review it is unlikely that further studies will be performed.
通过饲管进行肠内营养是为有足够胃肠功能但无法进食的住院患者提供营养支持以预防营养不良的一种常见且有效的方法。与幽门后鼻肠管相比，胃饲可能与食物误吸和肺炎的发生率较高有关。因此，肠内饲管直接放置于小肠而非胃内，有人推荐使用促动力药甲氧氯普胺来实现幽门后放置，但其疗效存在争议。此外，甲氧氯普胺可能会引起不良反应，高剂量或长期使用时可能会很严重且不可逆。
确定静脉注射甲氧氯普胺对成人鼻肠管幽门后放置的影响。
通过检索Cochrane对照试验中央注册库（CENTRAL；2014年第10期）来识别试验，该注册库包括CUGPD小组的专业试验注册库、MEDLINE（1996年至2014年10月21日）、EMBASE（1988年至2014年10月21日）、LILACS（2005年至2014年10月21日）。我们没有将检索局限于英文出版物。所有数据库检索最初于2005年1月更新，然后于2008年11月再次更新，并于2014年10月再次更新。2008年和2014年均未发现新的研究。
我们选择了需要肠内营养且接受静脉或肌肉注射甲氧氯普胺以辅助经幽门鼻肠饲管放置的成人随机对照试验，并与安慰剂或无干预进行比较。
我们采用了Cochrane协作网期望的标准方法程序。所有分析均按照意向性分析方法进行。我们给出风险比（RR）及95%置信区间（CI）。
纳入并分析了4项研究，共204名参与者。这些试验将甲氧氯普胺与安慰剂（2项试验）或无干预（2项试验）进行了比较。研究了10 mg（2项试验）和20 mg（2项试验）剂量的甲氧氯普胺。在促进饲管放置方面甲氧氯普胺与安慰剂或无干预之间无统计学显著差异（RR 0.82，95%CI 0.61至1.10）。与安慰剂或无干预相比，10 mg（RR 0.82，95%CI 0.60至1.11）和20 mg（RR 0.62，95%CI 0.15至2.62）剂量的甲氧氯普胺在促进幽门后插管方面同样无效。
在本综述中我们仅发现4项符合纳入标准的研究。这些研究规模小、效能不足，其中使用的甲氧氯普胺剂量为10 mg和20 mg。我们的分析表明，甲氧氯普胺无助于鼻肠饲管的幽门后放置。理想情况下应进行样本量足够大的随机临床试验，将甲氧氯普胺与对照进行比较，然而，鉴于本综述显示缺乏疗效，不太可能进行进一步研究。
