Lee Yen-Feng, Hsu Tien-Wei, Liang Chih-Sung, Yeh Ta-Chuan, Chen Tien-Yu, Chen Nai-Ching, Chu Che-Sheng
Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
J Am Med Dir Assoc. 2021 Feb;22(2):357-363. doi: 10.1016/j.jamda.2020.06.035. Epub 2020 Jul 29.
The current study aimed to conduct a systematic review and meta-analysis to explore the efficacy and safety of tube feeding in patients with advanced dementia.
Systematic review and meta-analysis.
PubMed, Medline, Embase, and Cochrane Library were searched from inception until March 7, 2020, to obtain relevant studies.
Feeding with nasogastric tube or percutaneous endoscopic gastrostomy (PEG).
We evaluated the associations of tube feeding and the risk of mortality, period of survival days, tube-related complications, and nutritional status. Data from original studies were synthesized by using a random-effects model. Each selected article was assessed for bias using the Newcastle-Ottawa Scale. A narrative synthesis and pooled analyses are reported.
Twelve trials were eligible, involving 1805 patients with tube feeding (mean age: 82.8 years; 71.3% female) and 3861 without tube feeding (mean age: 82.7; 68.7% female). For mortality rate, patients with advanced dementia with tube feeding are associated with significantly higher mortality rate [k = 8; odds ratio (OR) 1.79; 95% confidence interval (CI) 1.04-3.07; P = .03]. Initially, no association was found for the risk of pneumonia and pressure sore between groups. However, sensitivity analysis showed patients with advanced dementia with PEG tube feeding have significantly higher risk of pneumonia (OR 3.56; 95% CI 2.32-5.44; P < .001) and pressure sore (OR 2.25; 95% CI 1.92-2.63; P < .001). Finally, no association was found for the survival period and nutritional status between groups.
This meta-analysis indicates that tube feeding is associated with increased mortality rate and possible tube-related complications, but not improves with prolonging survival days and nutritional status. Shared decision-making routinely before insertion of a tube between caregivers and physicians is recommended.
本研究旨在进行系统评价和荟萃分析，以探讨晚期痴呆患者管饲的有效性和安全性。
系统评价和荟萃分析。
检索PubMed、Medline、Embase和Cochrane图书馆自建库至2020年3月7日的相关研究。
鼻饲或经皮内镜下胃造口术（PEG）喂养。
我们评估了管饲与死亡率、生存天数、管饲相关并发症及营养状况之间的关联。采用随机效应模型对原始研究数据进行综合分析。使用纽卡斯尔-渥太华量表对每篇入选文章进行偏倚评估。报告了叙述性综合分析和汇总分析结果。
12项试验符合条件，涉及1805例接受管饲的患者（平均年龄：82.8岁；71.3%为女性）和3861例未接受管饲的患者（平均年龄：82.7岁；68.7%为女性）。就死亡率而言，晚期痴呆接受管饲的患者死亡率显著更高[k = 8；比值比（OR）1.79；95%置信区间（CI）1.04 - 3.07；P = 0.03]。最初，两组间肺炎和压疮风险无关联。然而，敏感性分析显示，晚期痴呆接受PEG管饲的患者肺炎风险显著更高（OR 3.56；95% CI 2.32 - 5.44；P < 0.001）和压疮风险显著更高（OR 2.25；95% CI 1.92 - 2.63；P < 0.001）。最后，两组间生存期和营养状况无关联。
这项荟萃分析表明，管饲与死亡率增加及可能的管饲相关并发症相关，但并不能延长生存期和改善营养状况。建议护理人员和医生在插入饲管前常规进行共同决策。
