「不同鼻胃管灌食法對使用呼吸器病患之胃排空及肺吸入的成效」：利用統合分析方式檢定

Continuous Versus Intermittent Nasogastric Feeding for Patients on Mechanical Ventilation: Impacts on Gastric Emptying And Pulmonary Aspiration: A Comprehensive Systematic Review

黃怡真(Yi-chen Huang)

指導教授 ： 楊其璇

中臺科技大學/護理學院/護理研究所/碩士(2011年)

https://doi.org/10.6822/CTUST.2011.00069

摘要

隨著科技與醫療的進步，呼吸器的使用在現今醫療照護中扮演維持生命重要的角色，呼吸器為加護病房病患常用且重要的維生工具之一。長期使用鼻胃管易引起胃食道逆流及肺吸入。運用周全性系統文獻回顧來探討不同鼻胃管灌食法對使用呼吸器病患之胃排空及肺吸入的影響，以Comprehensive Meta-Analysis的套裝軟體進行統合分析。
研究結果顯示:統合分析鼻胃管灌食與胃排空的成效p＝.018，效應量95％ CI 0.089 ～ 2.236，顯示無顯著性。統合分析鼻胃管灌食與肺吸入的成效：共有7篇，其中有5篇研究比較是否有發生肺吸入，另2篇研究利用標準化平均差異。5篇研究中p＝.000，效應量95％ CI 0.116 ～ 1.633，顯示無顯著性。另2篇研究利用標準化平均差異，分別為痰液中性球及痰液吞油脂巨噬細胞，痰液中性球p＝.500，標準化平均差異95％ CI -2.454～-0.645，統計上有顯著性。痰液吞油脂巨噬細胞作p＝.508，標準化平均差異95％ CI -1.121～0.483，統計上無顯著性。統合分析的結果顯示不同鼻胃管灌食法對使用呼吸器病患之胃排空及肺吸入無顯著性差異。建議未來的研究可針對呼吸照護中心作為研究的對象，增加樣本數及降低疾病嚴重度的干擾因素。

關鍵字

肺吸入 ； 胃排空 ； 統合分析 ； 鼻胃管灌食

並列摘要

Every 100 patients receiving mechanical ventilation, 6-25 of them will acquire VAP. Nasogastric tube (NG) feeding is usually administered to patients on ventilator for nutritional support. Yet, evidences have shown NG feeding is one of contributing factors to VAP. Evidences also have shown long-term uses of ventilator could lead to gastroesophageal reflux and pulmonary aspiration in patients also receiving NG feeding. It is unclear which NG feeding methods affect the incidence of pulmonary aspiration. A comprehensive systematic literature review was conducted to explore the effects of different NG feeding on pulmonary aspiration and gastric emptying in patients on mechanically ventilation.
A broad computerized literature search was conducted using both Chinese and English databases, as well as the reference lists of relevant articles. A total of 9 Chinese databases, including Government Research Bulletin, and three English database, Medline, CINAHL and Cochrane, were searched. The selection criteria for eligible studies were: (a) The article contained original research data; (b) the study comparing continuous versus intermittent NG feeding, and (c) the article included at least one outcome measure of pulmonary aspiration or gastric emptying. When the same study was repeated published, the one article that included the most detailed or complete data information was used. Articles that presented reviews or summaries of previous research studies were excluded.
Articles that met selection criteria were carefully examined by two reviewers to make a final selection of the studies for this review. A total of seven studies were included in this comprehensive meta-analysis. They were generally small in sample size and of poor or moderate quality. Data were extracted and collected independently by the two reviewers and cross-checked. Comprehensive Meta-analysis version 2 (Biostate, 2006) was used to analysis statistical data extracted from retrieved articles and to conduct meta-analysis.For dichotomous variables, odds ratio and 95% confidence intervals (CI) were derived for each outcome where possible. For continuous variables, mean differences and 95% CI were calculated for each outcome.
The data from three trials, which comparing the impact of continuous and intermittent NG feeding on delayed gastric empty, were heterogeneous and indicated no significant difference between two modalities of NG feeding (odds ratio = 0.447, p = .327; 95% CI = 0.089~ 2.236). Five heterogeneous studies compared the incidences of pulmonary aspiration and no significant differences were found (odds ratio = 0.436, p = .218; 95% CI = 0.116～1.633). There were two heterogeneous studies compare the amounts of neutrophils in sputum between the two NG feeding methods. Results indicated that intermittent NG feeding had a better outcome in terms of less neutrophils present in sputum (St. Diff. in Mean = -1.550, p = .001; 95% CI = -2.454～-0.645). Another two trials compared the amount of lipid-laden macrophage presented in sputum suggested no differences between intermittent or continuous NG feeding (St. Diff. in Mean = -0.319, p = .436; 95% CI = -1.121～ 0.483)
There were no definitive studies showing either intermittent or continuous NG feeding is better in the outcomes of gastric emptying or the amount of lipid-laden macrophage presented in sputum. However, the result showed intermittent NG feeding is better than continuous NG feeding in terms of less neutrophils present in sputum. Nevertheless, the current strength of evidence is weak and well-designed studies are strongly recommended. Based on the current evidence, it is not possible to state that one NG feeding method is better than the other.

並列關鍵字

Pulmonary Aspiration ； Meta-Analysis ； Nasogastric Tube Feeding ； Gastric Emptying

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