Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials
Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials
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DOI：
10.1136/bmj.323.7316.773
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发表时间：
2001-10-06
影响因子：
--
通讯作者：
Thomas, S
中科院分区：
文献类型：
--
作者：
Lewis, SJ;Egger, M;Thomas, S
目的确定是否一段时间的饥饿（无口）胃肠道手术后是有益的，在特定outcome.Design随机对照试验的系统评价和荟萃分析比较任何类型的肠内喂养手术后24小时内开始与无口管理在择期胃肠道手术。三个电子数据库（PubMed，Embase，和科克伦对照试验注册）进行检索，检查参考文献列表，并向制药公司和以前试验的作者发送信件，要求提供未发表试验的详细信息和数据。结果11篇研究共837例患者符合纳入标准。在6项研究中，干预组的患者直接喂入小肠，在5项研究中，患者口服。早期喂养降低了任何类型感染的风险（相对风险0.72，95%置信区间0.54至0.98，P = 0.036）和平均住院时间（天数减少0.84，0.36至1.33，P=0.001）。还观察到吻合口裂开（0.53，0.26 - 1.08，P=0.080）、伤口感染、肺炎、腹腔内脓肿和死亡率的风险降低，但未达到显著性（P > 0.10）。结论胃肠道切除术后不经口进食的病人无明显的呕吐发生率。早期喂养可能是有益的，需要一个足够有力的试验来证实或反驳在小型试验中看到的益处。
Objective To determine whether a period of starvation (nil by mouth) after gastrointestinal surgery is beneficial in terms of specific outcomes.Design Systematic review and meta-analysis of randomised controlled trials comparing any type of enteral feeding started within 24 hours after surgery with nil by mouth management in elective gastrointestinal surgery. Three electronic databases (PubMed, Embase, and the Cochrane controlled trials register) were searched, reference lists checked, and letters requesting details of unpublished trials and data sent to pharmaceutical companies and authors of previous trials.Main outcome measures Anastomotic dehiscence, infection of any type, wound infection, pneumonia, intra-abdominal abscess, length of hospital stay, and mortality.Results Eleven studies with 837 patients met the inclusion criteria. In six studies patients in the intervention group were fed directly into the small bowel and in five studies patients were fed orally. Early feeding reduced the risk of any type of infection (relative risk 0.72, 95% confidence interval 0.54 to 0.98, P = 0.036) and the mean length of stay in hospital (number of days reduced by 0.84, 0.36 to 1.33, P=0.001). Risk reductions were also seen for anastomotic dehiscence (0.53, 0.26 to 1.08, P=0.080), wound infection, pneumonia, intra-abdominal abscess, and mortality, but these failed to reach significance (P > 0.10). The risk of vomiting was increased among patients fed early (1.27, 1.01 to 1.61, P = 0.046).Conclusions There seems to be no clear advantage to keeping patients nil by mouth after elective gastrointestinal resection. Early feeding may be of benefit An adequately powered trial is required to confirm or refute the benefits seen in small trials.