Cheatham M L, Chapman W C, Key S P, Sawyers J L
Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Ann Surg. 1995 May;221(5):469-76; discussion 476-8. doi: 10.1097/00000658-199505000-00004.
A meta-analysis of all published clinical trials comparing selective versus routine nasogastric decompression was performed in an attempt to evaluate the need for nasogastric decompression after elective laparotomy.
Many studies have suggested that routine nasogastric decompression is unnecessary after elective laparotomy and may be associated with an increased incidence of complications. Despite these reports, many surgeons continue to practice routine nasogastric decompression, believing that its use significantly decreases the risk of postoperative nausea, vomiting, aspiration, wound dehiscence, and anastomotic leak.
A comprehensive search of the English language medical literature was performed to identify all published clinical trials evaluating nasogastric decompression. Twenty-six trials (3964 patients) met inclusion criteria. The outcome data extracted from each trial were subsequently "pooled" and analyzed for significant differences using the Mantel-Haenszel estimation of combined relative risk.
Fever, atelectasis, and pneumonia were significantly less common and days to first oral intake were significantly fewer in patients managed without nasogastric tubes. Meta-analysis based on study quality revealed significantly fewer pulmonary complications, but significantly greater abdominal distension and vomiting in patients managed without nasogastric tubes. Routine nasogastric decompression did not decrease the incidence of any other complication.
Although patients may develop abdominal distension or vomiting without a nasogastric tube, this is not associated with an increase in complications or length of stay. For every patient requiring insertion of a nasogastric tube in the postoperative period, at least 20 patients will not require nasogastric decompression. Routine nasogastric decompression is not supported by meta-analysis of the literature.
对所有已发表的比较选择性与常规鼻胃减压的临床试验进行荟萃分析，以评估择期剖腹手术后鼻胃减压的必要性。
许多研究表明，择期剖腹手术后常规鼻胃减压并无必要，且可能与并发症发生率增加有关。尽管有这些报道，但许多外科医生仍继续进行常规鼻胃减压，认为其使用可显著降低术后恶心、呕吐、误吸、伤口裂开和吻合口漏的风险。
对英文医学文献进行全面检索，以确定所有评估鼻胃减压的已发表临床试验。26项试验（3964例患者）符合纳入标准。随后将从每项试验中提取的结局数据“汇总”，并使用Mantel-Haenszel合并相对风险估计法分析显著差异。
未使用鼻胃管治疗的患者发热、肺不张和肺炎明显较少见，首次经口进食天数也明显较少。基于研究质量的荟萃分析显示，未使用鼻胃管治疗的患者肺部并发症明显较少，但腹胀和呕吐明显较多。常规鼻胃减压并未降低任何其他并发症的发生率。
尽管患者在没有鼻胃管的情况下可能会出现腹胀或呕吐，但这与并发症增加或住院时间延长无关。对于术后需要插入鼻胃管的每一位患者，至少有20位患者不需要鼻胃减压。文献的荟萃分析不支持常规鼻胃减压。
