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经鼻胃管与幽门后管饲喂养在危重症患者中的应用:一项系统评价和荟萃分析。

Nasogastric tube versus postpyloric tube feeding for critical illness: A systematic review and meta-analysis.

机构信息

Department of Emergency medicine, Shanghai Fengxian District Central Hospital, Shanghai, China. Email:

Department of Neurology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China. Email:

出版信息

Asia Pac J Clin Nutr. 2024 Sep;33(3):283-297. doi: 10.6133/apjcn.202409_33(3).0001.

Abstract

BACKGROUND AND OBJECTIVES

Gastric tube feeding and postpyloric tube feeding are two common forms of enteral nutrition in critically ill patients. This study aimed to compare the efficacy and safety of gastric tube feeding with that of postpyloric tube feeding in critically ill patients.

METHODS AND STUDY DESIGN

PubMed, Embase, and Cochrane Library were systematically searched for eligible trials from their inception until March 2023. Relative risks (RRs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were used to estimate categorical and continuous outcomes using the random-effects model.

RESULTS

Sixteen trials involving 1,329 critically ill patients were selected for the final meta-analysis. Overall, we noted that gastric tube feeding showed no significant difference from post-pyloric tube feeding in mortality (p = 0.891), whereas the risk of pneumonia was significantly increased in patients who received gastric tube feeding (RR: 1.45; p = 0.021). Furthermore, we noted that gastric tube feeding was associated with a shorter time required to start feeding (WMD: -11.05; p = 0.007).

CONCLUSIONS

This research revealed that initiating feeding through the gastric tube required less time compared to postpyloric tube feeding. However, it was also associated with a heightened risk of pneumonia among critically ill patients.

摘要

背景与目的

胃管喂养和幽门后管喂养是危重症患者两种常见的肠内营养形式。本研究旨在比较胃管喂养与幽门后管喂养在危重症患者中的疗效和安全性。

方法和研究设计

系统检索了 PubMed、Embase 和 Cochrane Library 从成立到 2023 年 3 月的所有合格试验。使用随机效应模型,使用相对风险(RR)或加权均数差(WMD)及其 95%置信区间(CI)来评估分类和连续结局。

结果

最终的荟萃分析纳入了 16 项涉及 1329 例危重症患者的试验。总体而言,我们发现胃管喂养与幽门后管喂养在死亡率方面无显著差异(p = 0.891),但胃管喂养患者肺炎的风险显著增加(RR:1.45;p = 0.021)。此外,我们发现胃管喂养开始喂养所需的时间更短(WMD:-11.05;p = 0.007)。

结论

本研究表明,与幽门后管喂养相比,胃管喂养开始喂养所需的时间更短。然而,它也与危重症患者肺炎的风险增加有关。

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