鼻胃管与鼻空肠管喂养治疗重症急性胰腺炎:随机对照试验的系统综述

Q4 Medicine

Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru Pub Date : 2023-09-30 DOI:10.47892/rgp.2023.433.1542

Andrea Carlin-Ronquillo, Harold Benites-Goñi, Carlos Diaz-Arocutipa, Paulo Alosilla Sandoval, Alejandro Piscoya-Rivera, Lesly Calixto, Adrian V. Hernández

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引用次数: 0

摘要

早期通过饲管进行肠内营养对于重症急性胰腺炎(SAP)的治疗至关重要。与鼻胃管相比，鼻空肠管营养更能提供胰腺休息。然而，鼻空肠管放置是复杂的，可能延迟喂养开始，并可能增加医院费用。我们的目的是比较鼻胃管与鼻空肠管在SAP患者中肠内喂养的有效性和安全性。我们检索了四个数据库(PubMed, Web of Science, Scopus和Embase)，直到2022年12月1日。我们纳入了比较SAP患者鼻胃管和鼻空肠管肠内喂养的随机对照试验(rct)。主要结局是全因死亡率。次要结局为器官衰竭、感染、并发症、手术干预、管饲持续时间和住院时间。偏倚风险评估由两名研究者使用Cochrane RoB 2.0工具独立完成。我们使用逆方差法对随机效应模型进行meta分析。效果测量报告为相对危险度(RR)及其二分结局的95% ci和平均差异(MD)及其连续结局的95% ci。我们纳入了4项随机对照试验，涉及192例SAP患者，平均年龄在36 - 62岁之间。鼻胃喂养组和鼻空肠喂养组的全因死亡率无显著差异(18/98 vs. 23/93;Rr 1.34, 95%ci 0.77-2.30;p = 0.30)。各喂养组的所有次要结果均无显著差异。在随机化过程中，有三个rct存在一定的偏倚。综上所述，在SAP患者中，鼻胃管肠内喂养与鼻空肠管一样安全有效。需要更多参与者和更好设计的进一步随机对照试验来证实这些发现。

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Nasogastric versus nasojejunal tube feeding for severe acute pancreatitis: A systematic review of randomized controlled trials

Early enteral nutrition through a feeding tube is essential for the management of severe acute pancreatitis (SAP). Nasojejunal tube nutrition has been preferred on the assumption that it provided pancreatic rest in comparison to the nasogastric tube. However, nasojejunal tube placement is complex, may delay feeding initiation and can increase hospital costs. Our aim was to compare the efficacy and safety of enteral feeding with a nasogastric tube versus nasojejunal tube in patients with SAP. We searched four databases (PubMed, Web of Science, Scopus, and Embase) until December 1, 2022. We included randomized controlled trials (RCTs) comparing enteral feeding by nasogastric and nasojejunal tubes in patients with SAP. Primary outcome was all-cause mortality. Secondary outcomes were organ failure, infection, complications, surgical intervention, duration of tube feeding and length of hospital stay. Risk of bias assessment was completed independently by two investigators using the Cochrane RoB 2.0 tool. We performed random effects model meta-analyses using the inverse variance method. Effect measures were reported as relative risks (RR) and their 95% CIs for dichotomous outcomes and mean differences (MD) and their 95% CIs for continuous outcomes. We included four RCTs involving 192 patients with SAP. The mean ages ranged between 36 and 62 years old. There was no significant difference in all-cause mortality between the nasogastric and nasojejunal feeding arms (18/98 vs. 23/93; RR 1.34, 95%CI 0.77–2.30; p=0.30). There were no significant differences in all secondary outcomes between feeding arms. There were three RCTs with some concerns of bias, in the randomization process. In conclusion, in patients with SAP, enteral feeding delivered by nasogastric tube was as efficacious and safe as nasojejunal tube. Further randomized controlled trials with more participants and better design are needed to confirm these findings.

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来源期刊

Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru Medicine-Medicine (all)

CiteScore

0.40

自引率

0.00%

发文量

期刊介绍： La REVISTA DE GASTROENTEROLOGíA DEL PERÚ, es la publicación oficial de la Sociedad de Gastroenterología del Perú que publica artículos originales, artículos de revisión, reporte de casos, cartas e información general de la especialidad; dirigido a los profesionales de la salud con especial interés en la gastroenterología. La Revista de Gastroenterología del Perú es una publicación de periodicidad trimestral y tiene como objetivo la publicación de artículos científicos inéditos en el campo de la gastroenterología, proporcionando información actualizada y relevante de la especialidad y áreas afines. La Revista de Gastroenterología del Perú publica artículos en dos idiomas, español e inglés, a texto completo en la versión impresa yelectrónica. Los artículos científicos son sometidos a revisores o árbitros nacionales e internacionales, especialistas que opinan bajo la modalidad de doble ciego y de manera anónima sobre la calidad y validez de los mismos. El número de revisores depende del tipo de artículo, dos revisores como mínimo para artículos originales y uno como mínimo para otros tipos de artículos.