俯卧位通气患者肠内营养安全性和有效性的Meta分析

doi:10.3761/j.issn.0254-1769.2022.17.017

摘要/Abstract

摘要：

目的系统评价俯卧位通气患者肠内营养的安全性和有效性,为临床决策提供参考。方法计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Cochrane Library、Web of Science、Clinic trials数据库或平台中有关俯卧位通气患者肠内营养安全性和有效性的随机对照试验、类实验研究和队列研究,检索时限为建库至2021年1月。2名研究者依据纳入与排除标准筛选文献、提取资料并评价文献质量,使用RevMan 5.4软件进行统计分析。结果最终纳入9篇文献,共计461例俯卧位通气患者。Meta分析结果显示,俯卧位通气与仰卧位通气时进行肠内营养的患者在高水平胃残余量发生率[OR=0.89,95%CI（0.57,1.38）,P=0.60]、呕吐或反流发生率[RR=1.15,95%CI（0.89,1.48）,P=0.29]、呼吸机相关性肺炎发生率[RR=1.18,95%CI（0.77,1.81）,P=0.44]、肠内营养中断率[RR=1.42,95%CI（0.90,2.24）,P=0.13]、ICU住院时间[MD=-0.63,95%CI（-5.94,4.68）,P=0.82]等方面比较,差异均无统计学意义。结论对俯卧位通气患者进行肠内营养,不会增加其高水平胃残余量发生率、呕吐或反流发生率、呼吸机相关性肺炎发生率、肠内营养中断率以及ICU住院时间。但该研究纳入文献的数量有限、质量中等,后期仍需开展更多高质量的研究进一步验证该结论。

关键词: 俯卧位通气, 肠内营养, 喂养不耐受, 胃残余量, Meta分析, 危重病护理

Abstract:

Objective To systematically evaluate the safety and effectiveness of enteral nutrition in patients with prone ventilation,and to provide references for clinical decision-making. Methods CNKI,WanFang,VIP,SinoMed,PubMed,Embase,Cochrane Library,Web of Science,Clinic trials were searched for randomized controlled trials,quasi-experimental studies and cohort studies about the safety and efficacy of enteral nutrition in patients with prone ventilation published from inception to January 2021. There were 2 reviewers who screened the literature according to the inclusion and exclusion criteria,extracted data,and assessed the quality of included studies indepen-dently. Meta-analysis was conducted by RevMan 5.4. Results Finally,9 articles are included,with a total of 461 patients. The results of meta-analysis showed that compared with patients with supine position,there was no statistical significance for patients with enteral nutrition during prone position in the incidence of high gastric residual volume[OR=0.89,95%CI（0.57,1.38）,P=0.60],the incidence of vomiting or reflux[RR=1.15,95%CI（0.89,1.48）,P=0.29],ventilator associated pneumonia[RR=1.18,95%CI（0.77,1.81）,P=0.44],enteral nutrition interruption rate[RR=1.42,95%CI（0.90,2.24）,P=0.13],length of stay in ICU[MD=-0.63,95%CI（-5.94,4.68）,P=0.82]. Conclusion Enteral nutrition in prone patients had no significant effect on the incidence of high gastric residual volume,vomiting or regurgitation,ventilator-associated pneumonia,enteral nutrition interruption,or length of ICU stay. However,the quality of the included literature is limited,and more high-quality clinical studies are needed for further validation in the future.

Key words: Prone Position Ventilation, Enteral Nutrition, Feeding Intolerance, Gastric Residual Volume, Meta-Analysis, Critical Nursing Care

侯锦, 李奇, 李尊柱, 孙建华, 李欣, 赵明曦, 罗洪波, 郭爱敏. 俯卧位通气患者肠内营养安全性和有效性的Meta分析[J]. 中华护理杂志, 2022, 57(17): 2149-2155.

HOU Jin, LI Qi, LI Zunzhu, SUN Jianhua, LI Xin, ZHAO Mingxi, LUO Hongbo, GUO Aimin. Efficacy and safety of enteral nutrition in patients with prone position ventilation：a meta-analysis[J]. Chinese Journal of Nursing, 2022, 57(17): 2149-2155.

图/表 5

图1 PubMed检索策略

Figure 1 PubMed search strategy

图2 文献筛选流程图

Figure 2 Flow chart of literature screening

表1 纳入文献的基本特征（n=9）

Table 1 Basic characteristics of included literatures（n=9）

表2 类实验研究的方法学质量评价结果（n=2）

Table 2 Methodological quality evaluation results of quasi-experimental studies（n=2）

表3 队列研究的方法学质量评价结果（n=5）

Table 3 Methodological quality evaluation results of cohort studies（n=5）

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