肠内营养对食管癌患者术后临床结局影响的系统综述

doi:10.3969/j.issn.1004-583X.2023.06.001

摘要/Abstract

摘要：

目的运用meta分析评价肠内营养对食管癌患者术后临床结局及生活质量的影响。方法通过计算机检索Medline、Embase、Cochrane Central Register of Controlled Trials、Web of Science、BIOSIS Previews、clinical trials.gov、CNKI、SinoMed及WanFang Data数据库中2000年1月-2021年12月的所有有关食管癌术后肠内营养支持的随机对照试验,由两名研究者对检索出的文献进行筛选及数据提取,被提取的主要结局指标为肠内营养支持后的临床结局(并发症发生率、术后首次肛门排气时间、住院时间、住院费用)及总体生活质量,运用EndnoteX9进行文献筛选,运用RevMan 5.3进行meta分析。结果共检索出759项研究,经过筛选后最终纳入18项研究,研究对象共计1732人。分析结果显示营养干预组较对照组并发症发生率更低( RR =0.50,95% CI : 0.39, 0.64, P <0.01),术后首次肛门排气时间更短( MD =-33.32,95% CI : -54.27, -12.36, P <0.01),住院时间更少( MD =-1.40,95% CI : -2.25, -0.56, P <0.01),但总体生活质量( MD =2.39,95% CI : -2.02, 6.80, P =0.29)及住院费用( MD =-0.16,95% CI : -1.37, 1.06, P =0.80)较对照组差异无统计学意义。结论当前证据显示,肠内营养支持有助于改善食管癌患者术后临床结局,降低并发症发生率,促进肠道功能恢复,缩短住院时间。

关键词: 食管癌, 肠内营养, 临床结局, 随机对照试验, meta分析

Abstract:

Objective To evaluate the effect of enteral nutrition on postoperative clinical outcomes and the quality of life of patients with esophageal neoplasms by a meta-analysis. Methods Randomized controlled trials on enteral nutrition support for postoperative patients with esophageal neoplasms were searched in the databases of Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, BIOSIS Previews, Clinical trials.gov, CNKI, SinoMed, and WanFang Data database from January 2000 to December 2021. Two researchers were responsible for screening eligible literatures and extracting the data. The main outcomes, including the complication rate, the first time of postoperative anal exhaustion, length of stay, and hospitalization expenses, and the overall quality of life were extracted. Endnote X9 was used for literature screening and RevMan 5.3 was used for meta-analysis. Resultss A total of 759 studies were retrieved and ultimately 18 eligible studies with 1732 subjects were included. Meta-analysis results showed that after enteral nutrition support, patients in the intervention group had significantly lower rate of complications ( RR =0.50, 95% CI : 0.39, 0.64, P <0.01), shorter time of postoperative anal exhaustion ( MD =-33.32, 95% CI : -54.27, -12.36, P <0.01), and shorter length of stay than those of control group ( MD =-1.40, 95% CI : -2.25, -0.56, P <0.01). However, there were no significant differences in the overall quality of life ( MD =2.39, 95% CI : -2.02, 6.80, P =0.29) and hospitalization expenses ( MD =-0.16, 95% CI : -1.37, 1.06, P =0.80) between groups. Conclusion Current evidence shows that enteral nutrition support can help to improve the postoperative clinical outcome of patients with esophageal neoplasms, reduce the incidence of complications, promote the recovery of intestinal function, and shorten the length of stay.

Key words: esophageal neoplasms, enteral nutrition, elinical outcome, randomized controlled trial, meta-analysis

中图分类号:

尤奕, 高淑清, 徐浩. 肠内营养对食管癌患者术后临床结局影响的系统综述[J]. 临床荟萃, 2023, 38(6): 485-492.

You Yi, Gao Shuqing, Xu Hao. Effect of enteral nutrition on postoperative clinical outcome of esophageal neoplasms: A meta-analysis[J]. Clinical Focus, 2023, 38(6): 485-492.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.06.001

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I6/485

图/表 12

参考文献 30

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纳入研究	样本量	基线年龄(岁)		性别(男/女)		提取结局指标
纳入研究	样本量	干预组	对照组	干预组	对照组	提取结局指标
Chen, 2021^[5]	106	67.8±7.1	67.8±7.2	43/10	41/12	①
Pattamatta, 2021^[6]	135	65.0^*		77/58		④⑤
Pinto, 2021^[7]	80	66.0±10.4	61.0±8.9	33/5	38/4	⑤
Xie, 2021^[8]	77	61.6±8.5	63.1±5.8	33/9	29/6	①③⑤
王维, 2021^[9]	239	63.8±9.1	64.1±7.9	97/23	94/25	②③④
Yao, 2019^[10]	114	64.9±4.5	65.6±4.2	35/22	33/24	①②③
Liu, 2019^[11]	50	62.0±5.1	64.6±5.9	21/5	14/10	①③⑤
郭冬冬, 2019^[12]	120	63.5±3.6	65.8±2.8	42/18	36/24	⑤
王楠, 2019^[13]	100	50.7±10.3	50.4±10.4	26/24	28/22	①
许良翠, 2019^[14]	108	69.1±4.2	69.4±4.4	30/24	29/25	①②
刘冬梅, 2018^[15]	140	49.4±10.8	49.8±10.5	35/35	33/37	①⑤
Froghi, 2017^[16]	44	64.0±14.8	65.0±18.5	18/5	14/7	⑤
Furness, 2017^[17]	21	72.0±12.0	64.0±14.0	7/4	5/5	⑤
Gavazzi, 2016^[18]	79	67.0±8.9	69.0±13.3	15/23	15/26	⑤
Bowrey,2015^[19]	41	64.6±8.0	63.1±8.7	18/2	18/3	①④⑤
Carey, 2013^[20]	27	65.1±10.9	65.7±6.9	11/2	10/4	③⑤
贺明霞, 2006^[21]	216	62.0±8.0	63.0±8.0	NR	NR	①②
童本德, 2006^[22]	40	62.8±7.1		26/14		③

纳入研究	样本量	基线年龄(岁)		性别(男/女)		提取结局指标
纳入研究	样本量	干预组	对照组	干预组	对照组	提取结局指标
Chen, 2021^[5]	106	67.8±7.1	67.8±7.2	43/10	41/12	①
Pattamatta, 2021^[6]	135	65.0^*		77/58		④⑤
Pinto, 2021^[7]	80	66.0±10.4	61.0±8.9	33/5	38/4	⑤
Xie, 2021^[8]	77	61.6±8.5	63.1±5.8	33/9	29/6	①③⑤
王维, 2021^[9]	239	63.8±9.1	64.1±7.9	97/23	94/25	②③④
Yao, 2019^[10]	114	64.9±4.5	65.6±4.2	35/22	33/24	①②③
Liu, 2019^[11]	50	62.0±5.1	64.6±5.9	21/5	14/10	①③⑤
郭冬冬, 2019^[12]	120	63.5±3.6	65.8±2.8	42/18	36/24	⑤
王楠, 2019^[13]	100	50.7±10.3	50.4±10.4	26/24	28/22	①
许良翠, 2019^[14]	108	69.1±4.2	69.4±4.4	30/24	29/25	①②
刘冬梅, 2018^[15]	140	49.4±10.8	49.8±10.5	35/35	33/37	①⑤
Froghi, 2017^[16]	44	64.0±14.8	65.0±18.5	18/5	14/7	⑤
Furness, 2017^[17]	21	72.0±12.0	64.0±14.0	7/4	5/5	⑤
Gavazzi, 2016^[18]	79	67.0±8.9	69.0±13.3	15/23	15/26	⑤
Bowrey,2015^[19]	41	64.6±8.0	63.1±8.7	18/2	18/3	①④⑤
Carey, 2013^[20]	27	65.1±10.9	65.7±6.9	11/2	10/4	③⑤
贺明霞, 2006^[21]	216	62.0±8.0	63.0±8.0	NR	NR	①②
童本德, 2006^[22]	40	62.8±7.1		26/14		③

纳入研究	干预时间	营养筛查/评估	干预组		对照组
纳入研究	干预时间	营养筛查/评估	干预途径	营养制剂	干预途径	营养制剂
Chen, 2021^[5]	术后1月	NRS2002	空肠造口喂养	瑞能	经口进食	饮食教育+常规饮食
Pattamatta, 2021^[6]	术后1~20 d	NR	空肠造口喂养+经口	NR	空肠造口喂养+经口	常规饮食
Pinto, 2021^[7]	术后1月	NR	营养咨询+口服补充	NR	经口进食+标准护理	常规饮食
Xie, 2021^[8]	术后5~28 d	NR	口服补充+常规饮食	450kcal营养补充剂	经口进食	常规饮食
王维, 2021^[9]	术后1~8 s	NRS2002+PG-SGA	口服补充+常规饮食	NR	经口进食	常规饮食
Yao, 2019^[10]	术后1 d	NR	鼻-胃管	能全力	鼻-胃管	半流质+流质饮食
Liu, 2019^[11]	术后1 d~出院	NRS2002	口服补充+常规饮食	Peptisorb, nutricia	经口进食	流质饮食
郭冬冬, 2019^[12]	术后1~7 d	评估(未说明方法)	鼻-胃管	NR	鼻-胃管	常规护理+半流食、流食
王楠, 2019^[13]	术后~出院	NR	鼻-胃管	NR	鼻-胃管	常规护理
许良翠, 2019^[14]	术后2~8 d	NR	鼻-肠管	NR	鼻-肠管	常规护理
刘冬梅, 2018^[15]	术后1~7 d	NR	鼻-胃管	NR	鼻-胃管	常规护理
Froghi, 2017^[16]	术后~出院后6周	NR	空肠造口喂养	Fresubin original	空肠造口喂养+经口	流质饮食
Furness, 2017^[17]	术后~18周	NR	口服补充+常规饮食	NR	经口进食	常规饮食
Gavazzi, 2016^[18]	术后~出院后2月	NRS2002	鼻-肠管	NR	经口进食	营养咨询+常规饮食
Bowrey,2015^[19]	术后~出院后6周	NR	空肠造口喂养	NR	空肠造口喂养+经口	常规护理
Carey, 2013^[20]	术后~出院后6月	SGA	口服补充+常规饮食	NR	经口进食	营养咨询
贺明霞, 2006^[21]	术后1~10 d	NR	鼻-肠管	匀浆膳	鼻-肠管	常规饮食
童本德, 2006^[22]	术后24 h	NR	鼻-胃管	能全力	鼻-胃管	普通流质

纳入研究	干预时间	营养筛查/评估	干预组		对照组
纳入研究	干预时间	营养筛查/评估	干预途径	营养制剂	干预途径	营养制剂
Chen, 2021^[5]	术后1月	NRS2002	空肠造口喂养	瑞能	经口进食	饮食教育+常规饮食
Pattamatta, 2021^[6]	术后1~20 d	NR	空肠造口喂养+经口	NR	空肠造口喂养+经口	常规饮食
Pinto, 2021^[7]	术后1月	NR	营养咨询+口服补充	NR	经口进食+标准护理	常规饮食
Xie, 2021^[8]	术后5~28 d	NR	口服补充+常规饮食	450kcal营养补充剂	经口进食	常规饮食
王维, 2021^[9]	术后1~8 s	NRS2002+PG-SGA	口服补充+常规饮食	NR	经口进食	常规饮食
Yao, 2019^[10]	术后1 d	NR	鼻-胃管	能全力	鼻-胃管	半流质+流质饮食
Liu, 2019^[11]	术后1 d~出院	NRS2002	口服补充+常规饮食	Peptisorb, nutricia	经口进食	流质饮食
郭冬冬, 2019^[12]	术后1~7 d	评估(未说明方法)	鼻-胃管	NR	鼻-胃管	常规护理+半流食、流食
王楠, 2019^[13]	术后~出院	NR	鼻-胃管	NR	鼻-胃管	常规护理
许良翠, 2019^[14]	术后2~8 d	NR	鼻-肠管	NR	鼻-肠管	常规护理
刘冬梅, 2018^[15]	术后1~7 d	NR	鼻-胃管	NR	鼻-胃管	常规护理
Froghi, 2017^[16]	术后~出院后6周	NR	空肠造口喂养	Fresubin original	空肠造口喂养+经口	流质饮食
Furness, 2017^[17]	术后~18周	NR	口服补充+常规饮食	NR	经口进食	常规饮食
Gavazzi, 2016^[18]	术后~出院后2月	NRS2002	鼻-肠管	NR	经口进食	营养咨询+常规饮食
Bowrey,2015^[19]	术后~出院后6周	NR	空肠造口喂养	NR	空肠造口喂养+经口	常规护理
Carey, 2013^[20]	术后~出院后6月	SGA	口服补充+常规饮食	NR	经口进食	营养咨询
贺明霞, 2006^[21]	术后1~10 d	NR	鼻-肠管	匀浆膳	鼻-肠管	常规饮食
童本德, 2006^[22]	术后24 h	NR	鼻-胃管	能全力	鼻-胃管	普通流质

纳入研究	并发症种类
Chen, 2021^[5]	恶心、呕吐、腹泻、腹胀
Xie, 2021^[8]	胀气、腹泻、吞咽困难、恶心、呕吐、倾倒综合征、腹痛、胃痛、厌食、便秘
Yao, 2019^[10]	切口感染、胃肠反应、吻合口瘘、误吸
Liu, 2019^[11]	胀气、腹泻、吞咽困难、恶心、呕吐、倾倒综合征、吻合口狭窄、吻合口瘘
郭冬冬, 2019^[12]	腹胀、胃潴留、肺炎
许良翠, 2019^[14]	腹胀、恶心呕吐、出血、感染
刘冬梅, 2018^[15]	呕吐、吸入性肺炎、胃潴留、腹胀
Bowrey, 2015^[19]	腹泻、呕吐、管位移或迁移、意外拔管、管破裂、管口渗漏、堵管
贺明霞, 2006^[21]	切口感染、吻合口瘘、误吸、肺炎、乳糜胸、低蛋白血症、脓胸