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Early enteral feeding versus 'nil by mouth' after gastrointestinal surgery: systematic review and meta-analysis of controlled trials

机译:胃肠外科手术后早期肠内喂养与“零口吃”:对照试验的系统评价和荟萃分析

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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and the Cochrane controlled trials register) were searched, reference lists checked, and letters requesting details of unpublished trials and data sent to pharmaceutical companies and authors of previous trials.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.
机译:目的确定胃肠道手术后的饥饿时间(零口)是否对特定结局有益。设计比较随机对照试验的系统评价和荟萃分析,比较手术后24小时内开始的任何类型的肠内喂养与口服胃肠道手术中通过口管理的无肠喂养。搜索了三个电子数据库(PubMed,Embase和Cochrane对照试验注册),检查了参考文献清单,并要求提供未公开试验的详细信息以及发送给制药公司和先前试验作者的数据的信函。主要结局指标吻合口裂,任何类型的感染,伤口感染,肺炎,腹腔内脓肿,住院时间和死亡率。结果837例患者的11项研究符合纳入标准。在六项研究中,干预组的患者被直接喂入小肠,在五项研究中,患者被口服。早期喂养可降低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) )。吻合口裂开裂(0.53,0.26至1.08,P = 0.080),伤口感染,肺炎,腹腔内脓肿和死亡率也降低了风险,但均未达到显着水平(P> 0.10)。早期进食的患者呕吐的风险增加(1.27,1.01至1.61,P = 0.046)。结论选择性胃肠切除术后保持患者零口口似乎没有明显优势。早期喂养可能有益。需要充分动力的试验来确认或驳斥小型试验中看到的益处。

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