Lu Guanzhen, Xiang Qin, Wang Sha, Pan Mingyue, Xiang Xu, Yang Yanling, Shi Xinyan
Surgery Department, Huzhou Central Hospital, Affiliated Central Hospital, Huzhou University Huzhou 313000, Zhejiang, China.
Graduate School of Nursing, Huzhou University Huzhou 313000, Zhejiang, China.
Am J Transl Res. 2022 Apr 15;14(4):2134-2146. eCollection 2022.
Nasojejunal tubes (NJTs) are increasingly used in critically ill patients. NJT insertion with endoscopic- or x-ray-guidance can be achieved with success rates above 90%. This systematic review and meta-analysis of randomized controlled trials (RCTs) compares the efficiency and safety of these two methods in critically ill patients. We searched Chinese and English databases for RCTs comparing endoscopy- and x-ray-guided NJT placement published up to July 5, 2021. Meta-analyses were performed using RevMan5 software to compute mean differences (MDs) and odds ratios (ORs). Eleven RCTs (n=676) were included. The endoscopic group had a higher procedure success rate (OR=2.14, 95% CI [1.19, 3.85], Z=2.52, P=0.01) and shorter insertion time (MD=-3.70 min, 95% CI [-6.90, -0.50], Z=2.27, P=0.02) than the x-ray group. NJT indwelling time and post-insertion complications were similar between groups. The x-ray group had fewer complications during placement (OR=8.08, 95% CI [3.58, 18.22], Z=5.03, P<0.00001]; on subgroup analysis, only gastrointestinal non-bleeding adverse events differed significantly between groups (OR=2.78, 95% CI [1.43, 5.39], Z=3.03, P=0.002). Visual analog scale discomfort scores were better in the x-ray group (MD=4.10, 95% CI [3.57, 4.63], Z=15.07, P<0.00001). Compared with x-ray-guided NJT placement, endoscopy-guided placement was faster, had a higher success rate, and was associated with fewer gastrointestinal non-bleeding adverse events and less discomfort during insertion. Endoscopic guidance is recommended for NJT placement in critically ill patients to improve placement efficiency. X-ray guidance is a good alternative, depending on the hospital setting, as it is convenient, economical, and potentially safer.
鼻空肠管（NJTs）在重症患者中的应用越来越广泛。在内镜或X线引导下插入NJTs的成功率可达90%以上。本随机对照试验（RCT）的系统评价和荟萃分析比较了这两种方法在重症患者中的有效性和安全性。我们检索了中英文数据库，以查找截至2021年7月5日发表的比较内镜引导和X线引导下NJTs放置的RCT。使用RevMan5软件进行荟萃分析，以计算平均差（MDs）和比值比（ORs）。纳入了11项RCT（n = 676）。与X线组相比，内镜组的操作成功率更高（OR = 2.14，95%CI [1.19，3.85]，Z = 2.52，P = 0.01），插入时间更短（MD = -3.70分钟，95%CI [-6.90，-0.50]，Z = 2.27，P = 0.02）。两组之间的NJTs留置时间和插入后并发症相似。X线组在放置过程中的并发症较少（OR = 8.08，95%CI [3.58，18.22]，Z = 5.03，P < 0.00001）；亚组分析显示，两组之间仅胃肠道非出血不良事件存在显著差异（OR = 2.78，95%CI [1.43，5.39]，Z = 3.03，P = 0.002）。X线组的视觉模拟量表不适评分更好（MD = 4.10，95%CI [3.57，4.63]，Z = 15.07，P < 0.00001）。与X线引导下的NJTs放置相比，内镜引导下放置更快，成功率更高，胃肠道非出血不良事件更少，插入过程中的不适更少。对于重症患者的NJTs放置，建议采用内镜引导以提高放置效率。根据医院情况，X线引导是一种很好的替代方法，因为它方便、经济且可能更安全。
