Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Surgery, First Affiliated Hospital of Soochow University, Suzhou, China.
Ann Palliat Med. 2021 Jul;10(7):7406-7415. doi: 10.21037/apm-21-736.
Nutrition supports is essential to the prognosis of stroke patients with dysphagia. It's necessary to evaluate the effects and safety of intermittent tube feeding for stroke patients with dysphagia, to provide evidence for the management of dysphagia.
Cochrane Library et al. databases were searched for randomized controlled trials (RCTs) on the intermittent tube feeding for stroke patients with dysphagia up to Feb 15, 2021. Bias risk assessment tool recommended by Cochrane was used for quality assessment, and Revman5.3 software was used for data analysis.
A total of 11 RCTs involving 762 stroke patients with dysphagia were included. Meta-analysis indicated that intermittent tube feeding could significantly increase the rate of dysphagia function improvement [odd ratio (OR ) = 5.22, 95% confidence interval (CI): 3.38-8.07], serum albumin level [mean difference (MD) = 3.07, 95% CI: 1.65-4.49], hemoglobin level (MD =1.55, 95% CI: 1.19-1.95), prealbumin level (MD =1.79, 95% CI: 1.46-2.12), and reduce the incidence of aspiration pneumonia (OR = 0.28, 95% CI: 0.15-0.53), incidence of aspiration (OR =0.27, 95% CI: 0.08-0.93) for stroke patients with dysphagia (all P<0.05), o significant difference in the triceps skinfold thickness (TSF) (MD =0.46, 95% CI: -0.24 to 1.19) and arm muscle circumference (MD =0.04, 95% CI: -0.28 to 0.36) between two groups were found (all P>0.05). Egger regression tests indicated that there was no publication bias between included RCTs (all P>0.05).
Intermittent tube feeding for stroke patients with dysphagia during the recovery period can not only ensure the nutritional supply, but also promote the recovery of swallowing function and reduce the occurrence of aspiration and aspiration associated pneumonia.
营养支持对伴有吞咽困难的脑卒中患者的预后至关重要。有必要评估间歇管饲对伴有吞咽困难的脑卒中患者的疗效和安全性,为吞咽困难的管理提供证据。
检索 Cochrane Library 等数据库,截至 2021 年 2 月 15 日,纳入关于间歇管饲对伴有吞咽困难的脑卒中患者的随机对照试验(RCT)。采用 Cochrane 推荐的偏倚风险评估工具进行质量评价,Revman5.3 软件进行数据分析。
共纳入 11 项 RCT,涉及 762 例伴有吞咽困难的脑卒中患者。Meta 分析表明,间歇管饲能显著提高吞咽困难功能改善率[比值比(OR)=5.22,95%置信区间(CI):3.38-8.07]、血清白蛋白水平[均数差(MD)=3.07,95%CI:1.65-4.49]、血红蛋白水平(MD=1.55,95%CI:1.19-1.95)、前白蛋白水平(MD=1.79,95%CI:1.46-2.12),降低吸入性肺炎发生率(OR=0.28,95%CI:0.15-0.53)、吸入发生率(OR=0.27,95%CI:0.08-0.93)(均 P<0.05),两组间肱三头肌皮褶厚度(MD=0.46,95%CI:-0.24 至 1.19)和上臂肌围(MD=0.04,95%CI:-0.28 至 0.36)差异无统计学意义(均 P>0.05)。Egger 回归检验提示纳入的 RCT 间无发表偏倚(均 P>0.05)。
恢复期对伴有吞咽困难的脑卒中患者进行间歇管饲,不仅能保证营养供给,还能促进吞咽功能恢复,降低吸入和吸入性肺炎的发生。