收稿日期: 2025-04-18
网络出版日期: 2026-04-02
基金资助
2022年度赣州市指导性科技计划(20222ZDX7717)
Meta-analysis of the impact of gastric juice reinfusion on enteral feeding intolerance in critically ill patients
Received date: 2025-04-18
Online published: 2026-04-02
Supported by
Guiding Science and Technology Program of Ganzhou City in 2022(20222ZDX7717)
目的 系统评价回输胃液对重症患者肠内营养喂养不耐受的影响。 方法 系统检索PubMed、Web of Science、Cochrane Library、Ovid、CINAHL、Embase、中国生物医学文献数据库、中国知网、万方数据库、维普数据库中关于重症患者肠内营养回输胃液的随机对照试验，检索时限为建库至2025年1月26日。由2名研究员独立进行文献筛选、资料提取和质量评价，采用RevMan 5.4软件进行Meta分析。 结果 最终纳入8项随机对照试验，共574例患者。Meta分析显示，回输胃液在降低患者恶心/呕吐[RR=0.44，95%CI（0.21，0.95），P=0.036]、腹胀[RR=0.49，95%CI（0.31， 0.79），P=0.003]、便秘[RR=0.22，95%CI（0.05，0.99），P=0.048]的发生率上优于弃去胃液组，差异具有统计学意义。在胃残余量[MD=-9.55，95%CI（-21.83，2.73），P=0.127]、胃排空延迟发生率[RR=1.09，95%CI（0.72，1.65），P=0.692]、腹泻发生率[RR=0.60，95%CI（0.33，1.11），P=0.102]、血清白蛋白[SMD=0.18，95%CI（-0.13，0.49），P=0.248]、血浆总蛋白[SMD=0.18，95%CI（-0.13，0.50），P=0.245]和低血钾症发生率[RR=0.75，95%CI（0.47，1.18），P=0.213]方面的差异均无统计学意义。在血红蛋白[SMD=0.41，95%CI（-0.04，0.87），P=0.077]、电解质紊乱发生率[RR=0.56，95%CI（0.29，1.08），P=0.085]方面的差异接近统计学显著性。 结论 回输胃液在降低重症患者恶心/呕吐、腹胀及便秘的发生率方面具有优势，而在改善胃残余量、胃排空延迟、腹泻、营养学及电解质水平方面的效果不显著，需更多高质量随机对照试验进一步验证。在临床护理实践中，建议根据重症患者胃潴留的具体程度，循序渐进地实施胃液回输策略，以改善患者的胃肠道症状。
肖乐乐 , 肖莉 , 王婧 , 谢志芬 , 杨柳 , 刘晓兰 . 回输胃液对重症患者肠内营养喂养不耐受影响的Meta分析[J]. 中华急危重症护理杂志, 2026 , 7(4) : 488 -495 . DOI: 10.3761/j.issn.2096-7446.2026.04.018
Objective To systematically evaluate the impact of gastric juice reinfusion on enteral feeding intolerance in critically ill patients. Methods A systematic search was conducted in PubMed，Web of Science，Cochrane Library，Ovid，CINAHL，Embase，China National Knowledge Infrastructure，Wanfang Data，and VIP Database for randomized controlled trials（RCTs） regarding the reinfusion of gastric juice in critically ill patients receiving enteral nutrition. The search time period was from the establishment of the database to January 2025. Two researchers independently performed literature screening，data extraction，and quality assessment，with RevMan 5.4 software used for meta-analysis. Results A total of eight RCTs involving 574 patients were ultimately included. Meta-analysis indicated that reinfusion of gastric juice was superior to its disposal in reducing the incidence of nausea/vomiting[RR=0.44，95%CI（0.21，0.95），P=0.036]，abdominal bloating[RR=0.49，95%CI（0.31，0.79），P=0.003]，and constipation[RR=0.22，95%CI（0.05，0.99），P=0.048]，with statistically significant differences. However，there were no significant differences in gastric residual volume[MD=-9.55，95%CI（-21.83，2.73），P=0.127]，the incidence of gastric emptying delay[RR=1.09，95%CI（0.72，1.65），P=0.692]，diarrhea[RR=0.60，95%CI（0.33，1.11），P=0.102]，serum albumin（SMD=0.18，95%CI[-0.13，0.49]，P=0.248），plasma total protein（SMD=0.18，95%CI[-0.13，0.50]，P=0.245），or the incidence of hypokalemia（RR=0.75，95%CI[0.47，1.18]，P=0.213）. Differences in hemoglobin（SMD=0.41，95%CI[-0.04，0.87]，P=0.077） and the incidence of electrolyte disturbances（RR=0.56，95%CI[0.29，1.08]，P=0.085） were close to statistical significance. Conclusion Reinfusion of gastric juice is significantly advantageous in reducing the incidence of nausea/vomiting，abdominal bloating，and constipation，while its effects on improving gastric residual volume，gastric emptying delay，diarrhea，nutritional status，and electrolyte levels are not significant. Further validation with more high-quality RCTs is warranted. In clinical nursing practice，it is recommended to implement gastric juice reinfusion strategies gradually based on the specific degree of gastric retention in critically ill patients to improve gastrointestinal symptoms.
| [1] | Blaser AR, Starkopf J, Alhazzani W, et al. Early enteral nutri-tion in critically ill patients:ESICM clinical practice guide-lines[J]. Intensive Care Med, 2017, 43(3):380-398. |
| [2] | 包益萍, 张玲, 俞臻梁. 成人ICU患者肠内营养喂养不耐受风险预测模型的研究进展[J]. 中华急危重症护理杂志, 2023, 4(6):562-568. |
| Bao YP, Zhang L, Yu ZL. Research progress on risk prediction model of enteral nutrition feeding intolerance in adult ICU patients[J]. Chin J Emerg Crit Care Nurs, 2023, 4(6):562-568. | |
| [3] | 刘华, 米元元, 黄培培, 等. 危重症患者肠内营养喂养不耐受的研究进展[J]. 护士进修杂志, 2021, 36(4):333-338. |
| Liu H, Mi YY, Huang PP, et al. Research progress on feeding intolerance of enteral nutrition in critically ill patients[J]. J Nurses Train, 2021, 36(4):333-338. | |
| [4] | 杜静, 孙皎, 李婷, 等. 危重症患者肠内营养并发胃潴留护理的最佳证据总结[J]. 中华护理杂志, 2023, 58(23):2856-2864. |
| Du J, Sun J, Li T, et al. Summary of best evidence for the management of enteral nutrition with gastric retention in critically ill patients[J]. Chin J Nurs, 2023, 58(23):2856-2864. | |
| [5] | Wen ZJ, Xie AL, Peng MQ, et al. Is discard better than return gastric residual aspirates:a systematic review and meta-analysis[J]. BMC Gastroenterol, 2019, 19(1):113. |
| [6] | 王丽娟, 程云, 邹敏, 等. 回输鼻饲病人胃潴留液的系统评价[J]. 护理研究, 2014, 28(9):1040-1043. |
| Wang LJ, Cheng Y, Zou M, et al. System evaluation on reinfu-sion of gastric retention fluid for nasal feeding patients[J]. Chin Nurs Res, 2014, 28(9):1040-1043. | |
| [7] | Cumpston M, Li T, Page M J, et al. Updated guidance for tru-sted systematic reviews:a new edition of the Cochrane hand-book for systematic reviews of interventions[J]. Cochrane Data-base Syst Rev, 2019, 10(10):ED142. |
| [8] | Booker KJ, Niedringhaus L, Eden B, et al. Comparison of 2 me-thods of managing gastric residual volumes from feeding tubes[J]. Am J Crit Care, 2000, 9(5):318-324. |
| [9] | Juvé-Udina ME, Valls-Miró C, Carre?o-Granero A, et al. To re-turn or to discard? Randomised trial on gastric residual volu-me management[J]. Intensive Crit Care Nurs, 2009, 25(5):258-267. |
| [10] | Behairy AS, Elsedawy ED. Effect of returning versus discard-ing gastric aspirate on the occurrence of gastric complica-tions and comfort outcomes on enteral feeding patients[J]. J Nat Sci Res, 2014, 14(15):10. |
| [11] | 王红玉, 晏东波, 刘威威, 等. 胃液回输对住院ICU患者肠内营养支持效果的影响[J]. 世界华人消化杂志, 2016, 24(6):947-951. |
| Wang HY, Yan DB, Liu WW, et al. Influence of gastric fluid reinfusion on enteral nutrition support in intensive care unit patients[J]. World Chin J Dig, 2016, 24(6):947-951. | |
| [12] | 王丽娟, 陈皎, 邹敏. 回输胃潴留液对ICU危重病人胃残余量及并发症的影响[J]. 护理研究, 2017, 31(2):226-228. |
| Wang LJ, Chen J, Zou M. Influence of infusion of gastric fluid retention on gastric remnant and its complications in critical ICU patients[J]. Chin Nurs Res, 2017, 31(2):226-228. | |
| [13] | 贾雪丽. 探讨胃液回输对重症监护室患者早期肠内营养支持效果的影响[J]. 实用临床护理学电子杂志, 2018, 3(26):30,47. |
| Jia XL. To explore the effect of gastric juice reinfusion on early enteral nutrition support in ICU patients[J]. J Clin Nurs-ing’s Pract, 2018, 3(26):30,47. | |
| [14] | 贾雪丽. 经鼻盲放幽门后营养管实施胃液回输在ICU中的应用研究[J]. 中国实用护理杂志, 2019(9):708-712. |
| Jia XL. Application of nasorhal pylorus after the naso pylorus gastric tube reinfusion in ICU[J]. Chin J Pract Nurs, 2019(9):708-712. | |
| [15] | 张运梅. 胃液回输在重症监护室患者早期肠内营养支持中的应用效果[J]. 护理实践与研究, 2019, 16(21):148-149. |
| Zhang YM. Application effect of gastric juice reinfusion in early enteral nutrition support for patients in intensive care unit[J]. Nurs Pract Res, 2019, 16(21):148-149. | |
| [16] | 喻海涛, 蔡丽, 陈璐, 等. 基于容量的肠内营养输注方案对ICU患者营养摄入影响的Meta分析[J]. 中华急危重症护理杂志, 2023, 4(2):106-111. |
| Yu HT, Cai L, Chen L, et al. Meta-analysis of the effects of volume based feeding on nutrition intake of ICU patients[J]. Chin J Emerg Crit Care Nurs, 2023, 4(2):106-111. | |
| [17] | Raymenants K, Huang IH, Goelen N, et al. Clinical validation of the VIPUNTM gastric monitoring system versus manometry for the evaluation of gastric motility[J]. Neurogastroenterol Mo-til, 2024, 36(6):e14783. |
| [18] | 奉爱萍, 赵明曦, 孙建华, 等. 超声监测胃残余量在重症患者肠内营养中应用的Meta分析[J]. 中华现代护理杂志, 2021(8):1046-1052. |
| Feng AP, Zhao MX, Sun JH, et al. Application of ultrasonic monitoring of gastric residual volume in enteral nutrition of critically ill patients:a Meta-analysis[J]. Chin J Mod Nurs, 2021(8):1046-1052. | |
| [19] | Bachmann KF, Jenkins B, Asrani V, et al. Core outcome set of daily monitoring of gastrointestinal function in adult critically ill patients:a modified Delphi consensus process(COSMOGI)[J]. Crit Care, 2024, 28(1):420. |
| [20] | 王洪岩, 王玉果, 李梅花, 等. 自体胃液回输联合肠内营养对重型颅脑损伤胃瘫病人营养吸收的研究[J]. 肠外与肠内营养, 2019, 26(4):219-222,227. |
| Wang HY, Wang YG, Li MH, et al. A Study on nutrient absorption of patients with severe craniocerebral injury and gastroparesis by autologous gastric juice reinfusion combined with enteral nutrition[J]. Parenter Enter Nutr, 2019, 26(4):219-222,227. |
/
| 〈 |
|
〉 |