急性非静脉曲张性上消化道出血患者早期经口进食效果的Meta分析

doi:10.3761/j.issn.0254-1769.2023.03.011

摘要/Abstract

摘要：

目的系统评价急性非静脉曲张性上消化道出血（acute non-variceal upper gastrointestinal bleeding，ANVUGIB）患者止血后24 h内早期经口进食的安全性及有效性，为临床实践提供参考依据。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、Web of Science、Embase、Cochrane Library、CINAHL中关于ANVUGIB患者早期经口进食的随机对照试验和队列研究，检索时限为建库至2022年9月。由2名研究者对文献进行筛选、资料提取及方法学质量评价，并应用RevMan 5.4和Stata 13.0软件进行统计分析。结果共纳入4篇随机对照试验和1篇队列研究，文献质量评价结果均为B级。共纳入803例患者，其中试验组（早期经口进食）384例，对照组（常规禁食）419例。Meta分析结果示，两组再出血率[RR=0.87，95%CI（0.47，1.64），P=0.670]、病死率[RR=0.46，95%CI（0.19，1.08），P=0.080]、住院费用[SMD=-1.50，95%CI（-3.03，0.03），P=0.050]比较，差异无统计学意义；试验组住院时间少于对照组，两组比较，差异具有统计学意义[MD=-2.40，95%CI（-2.43，-0.12），P=0.030]。结论现有证据表明，ANVUGIB患者早期经口进食不仅不会增加其再出血率和病死率，还可缩短其住院时间，但对其住院费用无明显影响。由于纳入研究较少、样本量较小、早期经口进食具体实施情况存在差异，故仍需开展高质量、大样本、多中心的原始研究进一步验证早期经口进食的应用效果。

关键词: 急性非静脉曲张性上消化道出血, 早期经口进食, 再出血率, 病死率, Meta分析, 循证护理学

Abstract:

Objective The purpose of this meta-analysis was to systematically evaluate the safety and effectiveness of early oral feeding（received oral diet from day 1 after hemostasis） on patients with acute non-variceal upper gastrointestinal bleeding（ANVUGIB），and provide evidence references for clinical practice. Methods 8 electronic databases including SinoMed，China National Knowledge Infrastructure（CNKI），Wanfang data，VIP data，PubMed，the Cochrane Library，CINAHL，and Embase were searched for English and Chinese articles published on or before September，2022. There were 2 reviewers who retrieved articles，evaluated quality and extracted data independently. Review manager（RevMan） version 5.4 and Stata version 13.0 were then used to perform Meta-analysis. Results 4 RCTs and 1 cohort study with 803 cases of ANUGUIB were enrolled. Early oral feeding did not increase the rate of re-bleeding[RR=0.87，95%CI（0.47，1.64），P=0.670] or mortality[RR=0.46，95%CI（0.19，1.08），P=0.080]；while the length of hospital stay was shortened[MD=-2.40，95%CI（-2.43，-0.12），P=0.030]. However，the hospitalization costs[SMD=-1.50，95%CI（-3.03，0.03），P=0.050] in the early oral feeding group were not signifi-cantly different from those in the conventional feeding group. Conclusion The existing evidence shows that early oral feeding in patients with ANVUGIB does not increase the risk of poor prognosis and mortality，but also it can shorten the length of hospital stay，with no significant effect on reducing the hospital costs of patients. The included studies are few；the sample size is small；the specific implementation of early oral feeding is different. Therefore，high-quality，large-sample，multicenter original studies are still needed to further verify the application effect of early oral feeding.

Key words: Acute Non-variceal Upper Gastrointestinal Bleeding, Early Oral Feeding, Rebleeding Rate, Mortality Rate, Meta-analysis, Evidence-based Nursing

朱芮, 王珠珠, 张巧仙, 庄嘉元. 急性非静脉曲张性上消化道出血患者早期经口进食效果的Meta分析[J]. 中华护理杂志, 2023, 58(3): 334-341.

ZHU Rui, WANG Zhuzhu, ZHANG Qiaoxian, ZHUANG Jiayuan. The effect of early oral feeding in patients with acute non-variceal upper gastrointestinal bleeding：a systematic review and Meta-analysis[J]. Chinese Journal of Nursing, 2023, 58(3): 334-341.

图/表 7

图1 文献筛选流程

Figure 1 Flow chart of literature screening

表1 纳入文献的基本特征（n=5）

Table 1 Basic characteristics of the included literature（n=5）

表2 随机对照试验的方法学质量评价结果（n=4）

Table 2 Methodological quality assessment for the included randomized controlled trails（n=4）

图2 早期经口进食对急性非静脉曲张性上消化道出血患者再出血率的影响

Figure 2 Effect of early oral feeding on rebleeding rate in patients with acute non-variceal upper gastrointestinal bleeding

图3 早期进食对急性非静脉曲张性上消化道出血患者病死率的影响

Figure 3 Effect of early oral feeding on mortality in patients with acute non-variceal upper gastrointestinal bleeding

图4 早期经口进食对急性非静脉曲张性上消化道出血患者住院时间的影响

Figure 4 Effect of early oral feeding on length of stay in patients with acute non-variceal upper gastrointestinal bleeding

图5 早期经口进食对急性非静脉曲张性上消化道出血患者住院费用的影响注：任海霞等[9]研究的权重为32.1%，刘美玲[10]研究的权重为33.8%，Laine等[12]研究的权重为34.1%。

Figure 5 Effect of early oral feeding on hospitalization costs in patients with acute non-variceal upper gastrointestinal bleeding

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