| 摘要: | 研究目的：探討腦中風後合併吞嚥困難病人使用經皮內視鏡胃造口管與 鼻胃管之照護成效比較
研究設計：統合分析
研究方法：以統合分析為本研究之研究方法，由中、英文資料庫，根據研究問題所形成的關鍵字，檢索國內、外文獻，經由考科藍誤差風險評估工具第二版進行隨機對照試驗之文獻品質評選，非隨機對照試驗則以紐卡斯爾-渥太華量表進行文獻品質評選，並以Comprehensive Meta-Analysis 3.0軟體進行資料分析，探討腦中風後合併吞嚥困難病人使用經皮內視鏡胃造口（Percutaneous Endoscopic Gastrostomy, PEG）與鼻胃管（Nasogastric Tube, NGT）照護之成效，異質性分析以Cochran Q test及Higgins I2統計量判斷異質性程度，敏感性分析刪除不適合的文章，出版偏誤則運用Egger’s test確認有無存在。
研究結果：經過文獻篩選最終收錄9篇文獻，其中6篇為隨機對照試驗研究及3篇非隨機對照試驗研究，研究結果在營養成效方面，PEG組相對於NGT組灌食有較好的營養成效，除血紅素此項指標外，身體質量指數、體重、總蛋白質、血清白蛋白臨床指標，皆呈現統計上的顯著差異（p< .05），血清白蛋白指標中，依時間進行次群組分析，研究結果為使用PEG組比NGT組在3個月時，PEG組血清白蛋白值比NGT組平均值（Mean Difference, MD）明顯增加3.938，95%信賴區間（Confidence Interval, CI）為1.71-6.16，p= .001；吸入性肺炎發生率方面，PEG相對於NGT二組間統計上未達顯著差異（p> .05），但依時間進行次群組分析後，在3個月時，PEG組比NGT組有明顯較低的吸入性肺炎相對風險（Risk Ratio, RR）0.375，95% CI：0.19-0.736，p= .004；不良事件發生率方面，PEG組比NGT組在營養照護中斷方面有較低的發生率（p< .05）、消化道出血和逆流性食道炎方面統計上未顯著差異（p> .05）；死亡風險方面，PEG與NGT二組間統計上未顯著差異（RR：1.311，95% CI：0.74-2.33，p= .357），依時間進行次群組分析後，兩組使用灌食時間對死亡風險的影響在統計上未顯著差異（p> .05）。
結論：PEG組相對於NGT組有相對較好的營養成效、短期使用有較低的吸入性肺炎及營養照護中斷發生率，但在消化道出血和逆流性食道炎等不良事件發生率及死亡率上兩組未有差異，本研究結果可以列入護理教育課程，使護理人員照護病人時更加了解其風險，也可做為醫病共享決策實證，提供臨床上醫療照護者做出最適合的營養支持方法。
Objective: To explore the effectiveness of percutaneous endoscopic gastrostomy and nasogastric tube feeding for the post-stroke dysphagia patient.
Design: A meta-analysis.
Method: Based on the research method of meta-analysis, the Chinese and English databases were searched according to the search strategy of research question, and the literature quality of the randomized controlled trials (RCTs) was selected through the second version of the Cochrane risk of bias tool, and the non-randomized controlled trials (non-RCTs) were selected by the Newcastle-Ottawa scale, and the data analysis was carried out by Comprehensive Meta-Analysis 3.0 software was used to investigate the effectiveness of percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) care on patients with post-stroke Dysphagia. The degree of heterogeneity was determined by the Cochran Q test and Higgins I2 statistic, the sensitivity analysis was used to remove unsuitable articles, publication bias is confirmed by using the Egger's test.
Results: Nine articles were finally included, of which six were RCTs and three non-RCTs, the results showed that the PEG group had better nutritional effect than the NGT group, in addition to the hemoglobin, body mass value, body weight, total protein, serum albumin clinical indicators, all showed statistically significant differences (p< .05), in the serum albumin value, subgroup analysis was showed that the serum albumin value of the PEG group was significantly higher than that of the NGT group at three months compared with the NGT group MD:3.938, 95% CI: 1.71-6.16, p= .001）；The incidence of aspiration pneumonia, there was no significant difference between the PEG and NGT groups (p> .05), but after time-dependent subgroup analysis, the risk of aspiration pneumonia was significantly lower in the PEG group than in the NGT group at three months (RR: 0.375, 95% CI: 0.19-0.736, p= .004). The incidence of adverse events, the PEG group had a lower incidence of dislodgement/treatment failure than the NGT group (p< .05), and there was no statistically difference in gastrointestinal bleeding and reflux esophagitis (p> .05). The mortality risk, there was no statistically risk between PEG and NGT groups.
Conclusion: Compared with the NGT group, the PEG group had better nutritional efficacy and lower rates of aspiration pneumonia and nutritional care interruption in short-term use. However, there was no difference in the incidence of gastrointestinal bleeding, reflux esophagitis, and mortality between the two groups. The results can be included in nursing education courses, so that nursing can better understand the risks when caring for patients, and can also be used as evidence for Shared Decision-Making to provide clinically appropriate nutritional support methods for medical caregivers. |
