Efeito da goma de mascar para o restabelecimento da função intestinal após cesariana : revisão sistemática da literatura
Arquivos
Data
2017-06-29
Autores
Morais, Edna Pereira Gomes de 
Orientadores
Torloni, Maria Regina
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Realizar uma revisão sistemática para averiguar se a goma de mascar é efetiva para recuperar a função intestinal após cesariana. Método: Revisão sistemática realizada de acordo com a metodologia Cochrane. Foi realizada busca eletrônica nas bases de dados Cochrane Pregnancy and Childbirth Group's Trials Register, LILACs, ClinicalTrials.gov, WHO, International Clinical Trials Registry Plataform (ICTRP) e nas listas de referências dos estudos selecionados para leitura na íntegra. Não houveram restrições quanto ao período de publicação ou idioma dos estudos. Foram incluídos ensaios clínicos randomizados que compararam o uso da goma de mascar versus tratamento usual, para mulheres nas primeiras 24h apóscesariana. Desfechos primários: tempo até a primeira passagem de flatos, surgimento de íleo e tolerância ao uso de goma de mascar. Dois autores avaliaram independentemente a elegibilidade dos estudos, extraíram os dados e avaliaram o risco de viés conforme método padronizado pela Cochrane. As estimativas de efeito dos desfechos dicotômicos foram apresentadas como risco relativo (RR), com IC de 95%; para os desfechos contínuos, usamos a diferença de média (DM) e IC 95%. Avaliamos o risco de viés de cada estudo usando a tabela de risco de viés (Risk of Bias) e a qualidade geral das evidências pelo sistema GRADE. Resultados: Foram incluídos 17 ensaios clínicos randomizados, totalizando 3149 participantes, conduzidos em nove diferentes países. As mulheres que mascaram chiclete tiveram uma diminuição média no tempo até a primeira passagem de flatos de cerca de 7 horas (DM -7,09 horas, IC 95% -9,27 a -4,91 horas; 2399 participantes; 13 estudos; efeito randômico Tau2 = 14,63; I2 = 95%, evidência de qualidade muito baixa) e menor risco de desenvolver íleo (RR 0,39, IC 95% 0,19 a 0,80; 1.139 participantes; 4 estudos; I2 = 39%, evidência de baixa qualidade). A tolerância ao uso da goma de mascar foi alta. O grupo que mascou chiclete apresentou tempo até a primeira evacuação menor (DM -9,22 horas, IC 95% -11,49 a -6,95 horas; 2016 participantes; 11 estudos; efeito randômico Tau2 = 12,53; I2 = 93%, evidência de qualidade muito baixa), menor tempo de internação hospitalar (DM -0,36 dias, IC 95% -0,53 a -0,18 dias; 1489 participantes; 7 estudos, efeito randômico Tau2= 0,04; I2 = 92%) e redução do tempo até o surgimento dos primeiros ruídos hidroaéreos (DM – 4,56 horas, IC 95% -6,18 a -2,93 horas; 1729 participantes; 9 estudos; efeito randômico Tau2 = 5,41; I2 = 96%). Não houve diferença significativa entre os grupos quanto ao uso de analgésicos ou de agentes antieméticos no pós-operatório (RR 0,50; IC 95% 0,12 a 2,13; 726 participantes; três estudos; efeito randômico Tau2=0,79, I2= 69%). Nenhum estudo avaliou a satisfação da mulher quanto a ter que mascar goma. Conclusão: A evidência disponível sugere que mascar chiclete nas primeiras 24h após CS é uma intervenção bem tolerada que favorece a recuperação precoce da função intestinal. A qualidade da maioria dos estudos foi baixa ou incerta devido, principalmente à impossibilidade de mascarar as participantes e os profissionais de saúde quanto à intervenção. No geral, a qualidade da evidência foi baixa à muito baixa.
Objective: To assess the effects of chewing gum to reduce the duration of postoperative ileus and to enhance postoperative recovery after a cesarean section. Methods: Systematic review performed according to methodology of Cochrane Handbook of Systematic Reviews of Interventions. We searched the Cochrane Pregnancy and hildbirthGroup’s Trials Register, LILACs, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) and the reference lists of retrieved studies. No had limit to publication period and language. All randomised controlled trials comparing chewing gum versus usual care, for women in the first 24 hours after a cesarean was included. We included studies published in abstract form only. Two review authors independently selected the studies for inclusion, extracted data and assessed the risk of bias following standard Cochrane methods. We present dichotomous outcome results as risk ratio (RR) with 95% confidence intervals (CI) and continuous outcome results as mean differences (MD) and 95% CI. We pooled the results of similar studies using a random-effects model in case of important heterogeneity. We used the GRADE approach to assess the overall quality of evidence. Results: We included 17 randomised trials, 3149 participants, conducted in nine different countries. The women that chewed gum, the time to passage of first flatus was seven hours shorter (MD -7.09 hours, 95% CI -9.27 to 4.91 hours; 2399 women; 13 studies; random effects Tau² = 14.63, I² = 95%, very low-quality evidence) and the rate of ileus was on average over 60% lower in the chewing-gum group (RR=0.39, 95% CI 0.19 to 0.80; 1139 participants; four studies; I² = 39%, low-quality evidence). Tolerance to gum-chewing appeared to be high. The time to passage of faeces occurred on average nine hours earlier in the intervention group (MD -9.22 hours, 95% CI -11.49 to -6.95 hours; 2016 participants; 11 studies; random-effects Tau² = 12.53, I² = 93%, very lowquality evidence). The average duration of hospital stay was shorter in the intervention compared to the control group (MD -0.36 days, 95% CI -0.53 to -0.18 days; 1489 participants; seven studies; random-effects Tau² = 0.04, I² = 92%). The first intestinal sounds were heard earlier in the intervention than in the control group (MD -4.56 hours, 95% CI -6.18 to -2.93 hours; 1729 participants; nine studies; random-effects Tau² = 5.41, I² = 96%). None of the studies assessed women’s satisfaction in relation to having to chew gum. The need for analgesia or antiemetic agents did not differ between the intervention and control groups (average RR 0.50, 95% CI 0.12 to 2.13; 726 participants; three studies; random-effects Tau² = 0.79, I² = 69%). Conclusion: The available evidence suggests that gum chewing in the immediate postoperative period after a CS is a well tolerated intervention that enhances early recovery of bowel function. However the overall quality of the evidence is very low to low.
Objective: To assess the effects of chewing gum to reduce the duration of postoperative ileus and to enhance postoperative recovery after a cesarean section. Methods: Systematic review performed according to methodology of Cochrane Handbook of Systematic Reviews of Interventions. We searched the Cochrane Pregnancy and hildbirthGroup’s Trials Register, LILACs, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) and the reference lists of retrieved studies. No had limit to publication period and language. All randomised controlled trials comparing chewing gum versus usual care, for women in the first 24 hours after a cesarean was included. We included studies published in abstract form only. Two review authors independently selected the studies for inclusion, extracted data and assessed the risk of bias following standard Cochrane methods. We present dichotomous outcome results as risk ratio (RR) with 95% confidence intervals (CI) and continuous outcome results as mean differences (MD) and 95% CI. We pooled the results of similar studies using a random-effects model in case of important heterogeneity. We used the GRADE approach to assess the overall quality of evidence. Results: We included 17 randomised trials, 3149 participants, conducted in nine different countries. The women that chewed gum, the time to passage of first flatus was seven hours shorter (MD -7.09 hours, 95% CI -9.27 to 4.91 hours; 2399 women; 13 studies; random effects Tau² = 14.63, I² = 95%, very low-quality evidence) and the rate of ileus was on average over 60% lower in the chewing-gum group (RR=0.39, 95% CI 0.19 to 0.80; 1139 participants; four studies; I² = 39%, low-quality evidence). Tolerance to gum-chewing appeared to be high. The time to passage of faeces occurred on average nine hours earlier in the intervention group (MD -9.22 hours, 95% CI -11.49 to -6.95 hours; 2016 participants; 11 studies; random-effects Tau² = 12.53, I² = 93%, very lowquality evidence). The average duration of hospital stay was shorter in the intervention compared to the control group (MD -0.36 days, 95% CI -0.53 to -0.18 days; 1489 participants; seven studies; random-effects Tau² = 0.04, I² = 92%). The first intestinal sounds were heard earlier in the intervention than in the control group (MD -4.56 hours, 95% CI -6.18 to -2.93 hours; 1729 participants; nine studies; random-effects Tau² = 5.41, I² = 96%). None of the studies assessed women’s satisfaction in relation to having to chew gum. The need for analgesia or antiemetic agents did not differ between the intervention and control groups (average RR 0.50, 95% CI 0.12 to 2.13; 726 participants; three studies; random-effects Tau² = 0.79, I² = 69%). Conclusion: The available evidence suggests that gum chewing in the immediate postoperative period after a CS is a well tolerated intervention that enhances early recovery of bowel function. However the overall quality of the evidence is very low to low.