[1]张 锐,叶向红,王慧君,等.术前肠内营养对结直肠癌病人术后康复影响的Meta分析[J].肠外与肠内营养杂志,2021,(03):171-177.[doi:10.16151/j.1007-810x.2021.03.010]
 ZHANG Rui,YE Xiang-hong,WANG Hui-jun,et al.Effects of preoperative enteral nutrition on postoperative rehabilitation of colorectal cancer patients:a Meta-analysis[J].PARENTERAL & ENTERAL NUTRITION,2021,(03):171-177.[doi:10.16151/j.1007-810x.2021.03.010]
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术前肠内营养对结直肠癌病人术后康复影响的Meta分析
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2021年03期
页码:
171-177
栏目:
论著
出版日期:
2021-05-10

文章信息/Info

Title:
Effects of preoperative enteral nutrition on postoperative rehabilitation of colorectal cancer patients:a Meta-analysis
作者:
张 锐 1叶向红 2王慧君3薛阳阳2
1.南京大学医学院,江苏南京 210093;2.东部战区总医院普通外科研究所,江苏南京 210002;3.蚌埠医学院研究生院,安徽蚌埠 233000
Author(s):
ZHANG Rui1 YE Xiang-hong2 WANG Hui-jun3 XUE Yang-yang2
1. Medical College, Nanjing University, Nanjing 210093, Jiangsu, China;2. General Hospital of Eastern Theater Command, Research Institute of General Surgery, Nanjing 210002,Jiangsu,China;3. Graduate School, Bengbu Medical College, Bengbu 233000, Anhui, China
关键词:
结直肠癌 术前肠内营养 术后康复 Meta分析
Keywords:
Colorectal cancer Preoperative enteral nutrition Postoperative rehabilitation Meta-analysis
分类号:
R459.3
DOI:
10.16151/j.1007-810x.2021.03.010
文献标志码:
A
摘要:
目的:通过 Meta分析探讨术前肠内营养(EN)对结直肠癌病人术后康复的影响。 方法:计算机检索中国知网、万方、维普、PubMed、Web Of Science、OVID、Cochrane数据库中结直肠癌病人术前 EN与传统术前饮食(术前普通饮食,不额外补充营养)对病人术后恢复影响的随机对照研究。2名研究者分别对纳入文献质量进行评价后,用 RevMan 5.3进行统计分析。 结果:共纳入 9篇术前 EN对结直肠癌病人术后影响的文章。经 Meta分析,术后 3 d的总蛋白、前白蛋白以及白蛋白水平的测量结果有显著差异,分别为(MD = 7.35,95% CI:1.72 ~ 12.98,P =0.01)、(MD = 15.07,95% CI:12.48 ~ 17.67,P < 0.05)、(MD = 10.89,95% CI:5.15 ~ 16.62,P < 0.05);术后首次肛门排气时间测量结果为(SMD = -1.24,95% CI:-1.90 ~ -0.59,P < 0.05);病人术后感染性并发症发生状况的测量结果为(OR = 0.62,95% CI:0.42 ~ 0.93,P = 0.02);但住院时间差异无统计学意义。 结论:结直肠癌病人术前给予 EN能改善病人术后营养状况,加速病人术后肠道功能恢复,减少术后感染性并发症的发生率,促进病人术后康复,但仍需更多高质量的随机对照研究佐证研究结果。
Abstract:
Objective: To explore the effect of preoperative enteral nutrition on postoperative rehabilitation of patients with colorectal cancer by Meta-analysis. Methods: Randomized controlled trails on the effects of preoperative enteral nutrition and traditional preoperative diet on postoperative colorectal cancer patients were searched in the databases of CNKI, Wanfang, VIP, PubMed, Web of Science, OVID and Cochrane. After quality evaluation by two researchers , the literature were statistically analyzed by RevMan5.3. Results: Nine studies concerning the effect of preoperative enteral nutrition on postoperative outcomes of colorectal cancer patients were included. Significant differences were found among the levels of total protein, proprotein and albumin at 3 days after operation and the results were (MD = 7.35,95% CI:1.72 ~ 12.98,P = 0.01), (MD = 15.07,95% CI:12.48~ 17.67,P < 0.05) and (MD = 10.89,95%CI:5.15 ~ 16.62,P < 0.05), respecticely. Furthermore, the results of the first flatus time was (SMD=-1.24,95% CI:-1.90~-0.59,P < 0.05), and the results of the incidence of infectious complications was (OR = 0.62,95% CI:0.42 ~ 0.93, P =0.02), but there was no significant difference in the time of hospital stay. Conclusion: In colorectal cancer patients,preoperative enteral nutrition can improve postoperative nutritional status and accelerate the recovery of intestinal function. In addition, it can also reduce the incidence of postoperative infectious complications. However, more highquality randomized controlled trials are needed to support the results.

参考文献/References:


[1] 江志伟, 李 宁, 黎介寿 .恶性肿瘤病人营养支持的常见困惑 .外科理论与实践,2004,9(5):357-358.
[2] Adiamah A, Skorepa P, Weimann A, et al. The Impact of Preoperative Immune Modulating Nutrition on Outcomes in Patients Undergoing Surgery for Gastrointestinal Cancer A Systematic Review and Meta-analysis. Ann Surg, 2019, 270(2):247-256.
[3] 郑荣寿, 孙可欣, 张思维,等 . 2015年中国恶性肿瘤流行情况分析, 2019, 41(1):19-28.
[4] Lambert E, Carey S. Practice Guideline Recommendations on Perioperative Fasting: A Systematic Review. JPEN J Parenter Enteral Nutr,2016, 40(8):1158-1165.
[5] Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit.Clin Nutr,2019, 38(1):48-79.
[6] Munder T, Barth J.Cochrane's risk of bias tool in the context of psychotherapy outcome research. Psychother Res, 2018, 28(3):347-355.
[7] 陈珊珊, 孙 琳 .直结肠癌患者营养风险筛查及术前预防性肠内营养支持的效果分析 .中华全科医学,2017, 15(7):1242-1244.
[8] 李 卡, 郭海燕, 张静,等 .术前使用免疫增强型肠内营养对结直肠癌病人术后营养和并发症影响的前瞻性研究 .肠外与肠内营养,2014, 21(6):329-332.
[9] 朱开梅, 丁 瑜 .直肠癌患者术前加强营养护理的应用效果 .中国肿瘤临床与康复,2016, 23(4):475-477.
[10] Burden ST, Gibson DJ, Lal S, et al.Pre-operative oral nutritional supplementation with dietary advice versus dietary advice alone in weight-losing patients with colorectal cancer: single-blind randomized controlled trial.J Cachexia Sarcopenia Muscle,2017, 8(3):437-446.
[11] Burden ST, Hill J, Shaffer JL, et al. An unblinded randomised controlled trial of preoperative oral supplements in colorectal cancer patients.J Hum Nutr Diet,2011, 24(5):441-448.
[12] 黎 蓉, 邓 芳 .术前口服营养补充剂在结直肠癌患者快速康复治疗中的应用 .结直肠肛门外科,2019, 25(2):168-172.
[13] 梁伟雄, 张 彤, 洪 云, 等 .术前肠内免疫营养对结肠癌病人免疫功能的影响 .肠外与肠内营养,2006, 13(6):346-349.
[14] 梁伟雄,张 彤,洪 云,等 .管饲全肠内营养在大肠癌术前应用的临床研究 .中国实用外科杂志,2005,25(12):737-738.
[15] 邓 姣, 杨 静, 杨 荣 .肠内营养制剂在结、直肠癌术前肠道准备中的应用研究 . 现代生物医学进展,2010, 10(18):3497-3501.
[16] Wang Y, Zheng J, Gao Z, et al. Investigation on nutritional risk assessment and nutritional support status of surgical patients with colorectal cancer.J BUON,2018, 23(1):62-67.
[17] 胡德升, 董 星, 杨松鹏,等 .术前营养不良对结直肠癌患者术后感染及免疫功能的影响 .中华医院感染学杂志,2017, 27(24):5626-5629.
[18] 许 超, 池 畔 .结直肠癌根治术后肠梗阻的影响因素分析 .中华胃肠外科杂志,2014,17(4):361-364.
[19] Truong A, Hanna MH, Moghadamyeghaneh Z, et al.Implications of preoperative hypoalbuminemia in colorectal surgery. World J Gastrointest Surg,2016, 8(5):353-362.
[20] Hennessey DB, Burke JP, Ni-Dhonochu T, et al. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg, 2010, 252(2):325-329.
[21] 何 干, 杨 强, 白 錬, 等 .有营养风险的老年结直肠癌患者术前肠内营养的临床研究 . 重庆医学,2017, 46(10):1336-1338,1342.
[22] 陈 凛, 陈亚进, 董海龙,等 .加速康复外科中国专家共识及路径管理指南(2018版).中国实用外科杂志,2018, 38(1):1-20.
[23] 马华崇, 赵 琦, 赵 博,等 .肠内营养制剂在直肠癌术前肠道准备中的应用 .肠外与肠内营养,2012, 19(3):132-134,138.
[24] 梁洁云, 刘东滨, 范华迪 .肠内营养制剂在结直肠癌术前肠道准备中的应用 .中国临床营养杂志,2002, 10(2):109-111.
[25] 蒋晓松, 周新华 .短肽型营养制剂辅助手术前肠道准备效果的临床观察 .广东医学,2008, 29(5):828-830.
[26] 马雪玲, 白 燕, 王玉珏 .肠内营养制剂用于结直肠肿瘤术前肠道准备的效果观察 .天津护理,2015, 23(5):415-416.
[27] McClave SA, Taylor BE, Martindale RG, et al.Guidelines for theProvision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).JPEN J Parenter Enteral Nutr,2016, 40(2):159-211.
[28] 张泽峰, 徐建立, 张泽芳等 .不同肠内营养干预对直肠低位前切除术预防性造瘘患者肠道及肛门功能的影响 . 结直肠肛门外科,2016, 22(6):572-575.

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备注/Memo

备注/Memo:
基金项目 :军事医学创新工程项目(18CXZ040) 作者简介 :张 锐,护理硕士研究生,主要从事重症护理研究。E-mail:zhangruirio2020@163.com 通讯作者 :叶向红,E-mail:icuyz@126.com
更新日期/Last Update: 1900-01-01