咀嚼口香糖對降低結腸切除術後腸阻塞之功效

The Effect of Chewing Gum on Reducing Postoperative Ileus after Colorectal Surgery

董婉君(Wan-Chun Tung) ； 謝伶瑜(Ling-Yu Hsieh)

《台灣醫學》 19卷4期 (2015/07) Pp. 327-334

https://doi.org/10.6320/FJM.2015.19(4).01

摘要

術後腸阻塞是腹部手術常見的併發症，為了減少腸阻塞持續時間，臨床醫療有著不同的照護措施，如採較不具侵入性的腹腔鏡手術、硬膜外麻醉、早期下床及進食等，而咀嚼口香糖是一種模擬食物攝入的假性進食，是刺激腸蠕動功能的替代方法。本文進行統合分析以確定咀嚼口香糖對結腸切除術後患者排氣、排便及住院時間之成效。文獻搜尋2014年6月以前中、英文文獻，五個資料庫包括PubMed、Cochrane、Medline、CINAHL及華藝線上圖書館。進行結腸切除術後咀嚼口香糖之隨機控制試驗，並以Jadad Scale作為篩選文章品質工具。使用Review Manager 5.1版軟體進行統合分析，並以加權平均差及95%信賴區間呈現。共得6篇隨機臨床試驗，包含312位研究對象。研究結果顯示，咀嚼口香糖對結腸切除術後患者能顯著縮短排氣、排便時間，其總效益值依序為-12.45小時（95%CI：-22.53，-2.38，P=.02）及-16.15小時（95% CI：-25.36，-6.94，p＜0.001），而對縮短住院時間亦有成效，總效益值為-2.44天（95% CI：-3.10，-1.77，p＜0.001）。本研究提供較客觀之統合分析結果，可作為臨床醫護人員臨床應、用之參考依據，而未來仍需繼續進行嚴謹、大規模、盲化的隨機對照試驗並更新統合結果。

關鍵字

咀嚼口香糖 ； 腸阻塞 ； 結腸切除術 ； 統合分析

並列摘要

Postoperative ileus is a common complication after abdominal surgery. Various surgical techniques and perioperative approaches such as using of laparoscopic procedures, epidural analgesia, early mobilization and early feeding have been shown to facilitated recovery from ileus. Chewing gum is a form of sham feeding that stimulates bowel motility. The study conducted a meta-analysis to summarize the effect of chewing gum in reducing time to flatus, time to bowel movement, and length of hospital stay. The literature search focused on articles published before May 2014, and the following databases were searched: PubMed, Cochrane Library, MEDLINE, CINAHL, and Airiti Library. We aimed to identify all randomized controlled trials (RCTs) comparing with and without the use of chewing gum in patients after colorectal surgery. Study quality was assessed using Jadad scale. Statistical analyses were performed using Review Manager, version 5.1 and weighted mean difference (WMD) with 95% confidence intervals. Six RCTs with 312 patients were included. The results showed that chewing gum was effective on reducing in time to flatus by 12.45 hr (95% CI: -22.53 to -2.38, p=0.02), and time to bowel movement by 16.15 hr (95% CI: -25.36 to -6.94, p＜0.001). Length of hospital stay was also reduced in the treatment group by 2.44 d (95% CI: -3.10 to 1.77, p＜0.001). The research provided objective and synthetic results to encourage clinical staff using them as the reference basis for application. More large size, blinded RCTs are warranted in the future.

並列關鍵字

chewing gum ； ileus ； colorectal surgery ； meta-analysis

參考文獻

Holte K, Kehlet H: Postoperative ileus: a preventable event. Br J Surg 2000;87:1480-93.

Mattei P, Rombeau JL: Review of the pathophysiology and management of postoperative ileus. World J Surg 2006;30:1382-91.

Doorly MG, Senagore AJ: Pathogenesis and clinical and economic consequences of postoperative ileus. Surg Clin North Am 2012; 92:259-72, viii.

Asao T, Kuwano H, Nakamura J, et al: Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg 2002; 195: 30-2.

Kehlet H, Holte K: Review of postoperative ileus. Am J Surg 2001;182:3S-10S.