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皮肤内镜胃口术后何时食:随机对照试验的系统审查和元分析
Matthew L Bechtold1,2, Zahid Ijaz Tarar1,2, Muhammad N Yousaf1,2
1Division of Gastroenterology and Hepatology, Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA.
概括
通过皮肤内镜胃口 (PEG) 放置后早期 (在4小时内) 开始食是安全的,并且与延迟食相比没有增加的并发症. 这一元分析支持未来指南中早期养建议.
科学领域:
- 胃肠病学 胃肠病学
- 临床营养学 临床营养学
- 外科手术的结果
背景情况:
- 皮肤内镜胃口 (PEG) 放置后开始肠道养的最佳时间仍然是临床辩论的主题.
- 现有的随机对照试验 (RCT) 将早期与PEG后延迟养进行比较,产生了不一致的结果,需要进一步合成.
- 这一元分析旨在澄清PEG放置后早期食启动的安全性和有效性.
研究的目的:
- 进行元分析,比较PEG放置后的早期养 (≤4小时) 与延迟养 (>4小时).
- 评估食时间对整体和个体并发症,短期死亡率和胃残留体积的影响.
- 为后PEG养方案提供基于证据的建议.
主要方法:
- 2024年1月进行了系统的文献搜索,以确定相关的同行评审RCT.
- 包括比较早期养 (≤4小时) 与延迟养 (>4小时) 后PEG的RCT.
- 计算了整体并发症,特定并发症,72小时内死亡率和第一天胃残留体积的综合估计.
主要成果:
- 分析了6项涉及467名患者的RCT.
- 在早期和延迟养组之间没有观察到统计学上显著的差异,对整体并发症 (P=0.18).
- 72小时内死亡率 (P=0.3) 和第一天胃残留量 (P=0.05) 也没有显著差异. 吐,伤口感染,出血和腹等个人并发症在两组之间没有显著差异.
结论:
- 与延迟养相比,在PEG放置后4小时内开始养不会导致小或重大并发症的增加.
- 在PEG放置后早期食 (≤4小时) 是安全的临床实践.
- 这些发现支持在未来的PEG管理临床指南中推早期养.
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