Hogan Sophie, Steffens Daniel, Rangan Anna, Solomon Michael, Carey Sharon
Royal Prince Alfred Hospital, Sydney, NSW, Australia.
University of Sydney, Sydney, NSW, Australia.
Eur J Clin Nutr. 2019 Oct;73(10):1331-1342. doi: 10.1038/s41430-019-0474-1. Epub 2019 Jul 31.
BACKGROUND/OBJECTIVES: Despite best practice guidelines, feeding methods after colorectal surgery vary due to the difficulties translating evidence into practice. The aim was to determine the effectiveness of diets delivered into the gastrointestinal tract (GIT) on gut motility following colorectal surgery.
SUBJECTS/METHODS: EMBASE, MEDLINE, CINAHL, Web of Science and PubMed were systematically searched. Randomised controlled trials investigating effectiveness of a diet on gut motility after colorectal surgeries were included. Outcomes included postoperative ileus, length of stay, mortality, nausea and vomiting.
A total of 756 potential studies were identified; of these, 10 trials reporting on 1237 unique patients were included. There is evidence that early feeding reduces time (days) to first flatus (mean difference (MD):-0.64; 95% CI:-0.84 to -0.44) and bowel movements (MD:-0.64; 95% CI:-1.01 to -0.26), when compared to traditional postoperative fasting. Introducing solids versus the progression of fluids to solids had no effect on time (days) to first flatus (MD:0.13; 95% CI:-1.99 to 1.74) or bowel movement (MD:0.20; 95% CI:-0.50 to 0.98). Complete nutrition compared to hypocaloric nutrition had no effect on time to first flatus (MD:-0.60; 95% CI:-1.66 to 0.46) or bowel movement (MD:-0.20; 95% CI:-1.59 to 1.19), whereas coffee and diet compared to water and diet significantly decreased time (days) to first bowel movement (MD:-0.60; 95% CI:-0.97 to -0.19) but had no effect on time to first flatus (MD:-0.20; 95% CI:-0.57 to 0.09).
Any form of early postoperative diet provided into the GIT early after colorectal surgery is likely to stimulate gut motility, resulting in earlier return of bowel function and shorter length of stay.
背景/目的：尽管有最佳实践指南，但由于难以将证据转化为实际操作，结直肠手术后的喂养方法各不相同。目的是确定经胃肠道（GIT）给予的饮食对结直肠手术后肠道蠕动的有效性。
受试者/方法：系统检索了EMBASE、MEDLINE、CINAHL、Web of Science和PubMed。纳入了调查饮食对结直肠手术后肠道蠕动有效性的随机对照试验。结果包括术后肠梗阻、住院时间、死亡率、恶心和呕吐。
共识别出756项潜在研究；其中，纳入了10项试验，涉及1237例独特患者。有证据表明，与传统术后禁食相比，早期喂养可减少首次排气时间（天数）（平均差（MD）：-0.64；95%置信区间：-0.84至-0.44）和排便时间（MD：-0.64；95%置信区间：-1.01至-0.26）。引入固体食物与从流食过渡到固体食物对首次排气时间（天数）（MD：0.13；95%置信区间：-1.99至1.74）或排便时间（MD：0.20；95%置信区间：-0.50至0.98）没有影响。与低热量营养相比，全营养对首次排气时间（MD：-0.60；95%置信区间：-1.66至0.46）或排便时间（MD：-0.20；95%置信区间：-1.59至1.19）没有影响，而与水和饮食相比，咖啡和饮食显著缩短了首次排便时间（天数）（MD：-0.60；95%置信区间：-0.97至-0.19），但对首次排气时间没有影响（MD：-0.20；95%置信区间：-0.57至0.09）。
结直肠手术后早期经胃肠道给予任何形式的术后饮食都可能刺激肠道蠕动，从而使肠道功能更早恢复，住院时间更短。
