Systematic Review And Meta Analysis Of Early Postoperative Enteral Nutrition In Patients With Esophageal And Cardiac Tumors

Objective:By referring to relevant screening literature,a randomized controlled study on postoperative parenteral nutrition and early parenteral nutrition in patients about esophagal-cardiac malignancies was selected,the application of meta analysis to compare the effect of two different nutrition and postoperative complications,and attempts to explain the differences from the aspects of physiology,so as to provide the basis for clinical choice way of nutritional support.Methods:Relevant literatures were retrieved from 8 large databases,Including CNKI、Wanfang database、VIP database、CBM、Pubmed、Embase、Cochrane、WOS,High-quality literatures that met the inclusion criteria were selected to conduct meta analysis on the 11 aspects studied in this paper.Results:There were 1634 patients in early enteral nutrition group(EEN)and 1577 patients in parenteral nutrition group(PN).Compared with parenteral nutrition,the incidence of anastomotic fistula(OR=0.56,95%CI:0.39-0.82,Z=3.03P=0.02<0.05),pulmonary infection(OR=0.39,95%CI:0.30-0.51,Z =6.85,P<0.00001)and surgical incision infection(OR=0.44,95%CI:0.26-0.75,Z =3.06,P=0.002<0.05)were lower in early enteral nutrition and the study was statistically significant;The incidence of abdominal discomfort(OR =1.15,95%CI:0.69-1.91,Z =0.53,P=0.60>0.05)was not statistically significan;Serum transferrin(OR =0.29,95%CI: 0.23-0.36,Z =8.51,P<0.0001),serum albumin(MD =0.29,95%CI:0.23-0.36,Z =8.51,P<0.0001)and serum total protein(SMD =0.81,95%CI:0.43-1.19,Z =4.17,P<0.0001)were statistically significant;In terms of humoral immunity:Ig A(SMD =0.45,95%CI:0.16～0.74,P=0.002<0.05)、Ig M(SMD =0.40,95%CI:0.22～0.58,P<0.0001)and Ig G(SMD =1.01,95%CI:0.54～1.49,P<0.0001)are Statistically significant;In terms of liver damage:ALT(SMD =-7.20,95%CI:-11.43～-2.98,P=0.0008<0.05)and AST(SMD =-10.36,95%CI:-14.99～-5.74,P<0.0001<0.05)are Statistically significant;There was statistical significance in the first time of intestinal hand ventilation(SMD =-2.29,95%CI:-2.74～-1.84,Z =9.90,P<0.00001)between the two groups.Conclusion: The meta analysis showed that esophageal and cardiac malignant tumor patients with early postoperative enteral nutrition in the incidence of anastomotic fistula,incidence of pulmonary infection,surgical incision infection rate compared with parenteral nutrition has certain advantages,early enteral nutrition on liver function damage small and fast promote the intestinal function recovery is beneficial to the patients’ rapid recovery,it is a preferred way of nutritional support.