咀嚼口香糖对剖宫产术后产妇胃肠功能影响的Meta分析

doi:10.12280/gjszjk.20200482

摘要/Abstract

摘要：

目的：通过Meta分析,探讨咀嚼口香糖对剖宫产孕妇术后胃肠功能恢复的影响。方法：计算机检索PubMed、Cochrane Library、Embase、Medline、中国生物医学文献数据库（CBM）、维普数据库、万方数据库和中国知网等数据库中关于咀嚼口香糖和剖宫产术后胃肠功能恢复的随机对照研究。在文献筛选、提取数据、纳入文献质量评价后,运用Stata 14.0软件进行数据分析。结果：本研究共纳入27篇随机对照研究,其中中文文献6篇,英文文献21篇,共计4 008例患者,其中试验组1 983例、对照组2 025例。Meta分析结果表明,与对照组相比,试验组可有效促进剖宫产术后肠鸣音（WMD=-5.30,95%CI：-7.14~-3.46,P<0.000 1）及胃肠蠕动（SMD=-3.82,95%CI：-5.15~-2.49,P<0.000 1）的恢复,缩短肛门排气（WMD=-6.90,95%CI：-8.96~-4.85,P<0.000 1）及排便时间（WMD=-7.64,95%CI：-10.59~-4.69,P<0.000 1）,减少术后肠梗阻发生率（RR=0.15,95%CI：0.10~0.22,P<0.000 1）及患者住院时间（SMD=-0.73,95%CI：-1.11~-0.34,P<0.000 1）。结论：剖宫产术后咀嚼口香糖可有效促进胃肠功能的早期恢复,但纳入研究间异质性差异较为明显,未来需要更多标准化、多中心、大样本和高质量的临床研究来进一步验证。

关键词: 咀嚼, 口香糖, 剖宫产术, 手术后期间, 胃肠活动, 功能恢复, Meta分析

Abstract:

Objective: To evaluate the effect of chewing gum on the gastrointestinal function after cesarean section by meta-analysis. Methods: We electronically searched databases including PubMed, Cochrane Library, Embase, Medline, Chinese Biomedical Literature Database (CBM), Weipu Database (VIP), Wanfang Database and China National Knowledge (CNKI) for the randomized controlled trials (RCTs) on chewing gum and gastrointestinal function recovery after cesarean section. Based on literature screening, data extraction and inclusion were analyzed using Stata 14.0 software after the quality evaluation of literatures. Results: A total of 27 RCTs were included, including 6 Chinese literatures and 21 English literatures, involving 4 008 patients, including 1 983 in the experimental group and 2 025 in the control group. The bowel sound after operation was effectively promoted in the experiment group when compared with the control group (WMD=-5.30, 95%CI: -7.14--3.46, P<0.000 1), and the gastrointestinal peristalsis recovery also improved (SMD=-3.82, 95%CI: -5.15--2.49, P<0.000 1). Two times of anal exhaust (WMD=-6.90, 95%CI: -8.96--4.85, P<0.000 1) and defecation (WMD=-7.64, 95%CI: -10.59--4.69, P<0.000 1) were significantly shorter in the experiment group. More significantly, the incidence of postoperative intestinal obstruction was decreased (RR=0.15, 95%CI: 0.10-0.22,P<0.000 1), and the hospitalization time was shortened in the experiment group when compared with the control group (SMD=-0.73, 95%CI: -1.11--0.34, P<0.000 1). Conclusions: Chewing gum after cesarean section can effectively promote the early recovery of gastrointestinal motility function, although the heterogeneity of the included studies is obvious. In the future, more standardized, multi-center, large-sample and high-quality clinical studies are needed for further verification.

Key words: Mastication, Chewing gum, Cesarean section, Postoperative period, Gastrointestinal motility, Recovery of function, Meta-analysis

姜同灿, 王佩茹, 陶峰, 陈红波. 咀嚼口香糖对剖宫产术后产妇胃肠功能影响的Meta分析[J]. 国际生殖健康/计划生育, 2021, 40(2): 102-110.

JIANG Tong-can, WANG Pei-ru, TAO Feng, CHEN Hong-bo. Effect of Chewing Gum on Gastrointestinal Function after Cesarean Section：A Meta-Analysis[J]. Journal of International Reproductive Health/Family Planning, 2021, 40(2): 102-110.

图/表 10

参考文献 47

[1]	Lepore M, Fitzgerald JE. Gum chewing is associated with early recovery of bowel motility and shorter length of hospital stay for women after caesarean section[J]. Evid Based Med, 2015,20(1):22. doi: 10.1136/ebmed-2014-110058. doi: 10.1136/ebmed-2014-110058 URL pmid: 25525040
[2]	Lumbiganon P, Laopaiboon M, Gülmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08[J]. Lancet, 2010,375(9713):490-499. doi: 10.1016/s0140-6736(09)61870-5. doi: 10.1016/S0140-6736(09)61870-5 URL pmid: 20071021
[3]	Li HT, Luo S, Trasande L, et al. Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China, 2008-2014[J]. JAMA, 2017,317(1):69-76. doi: 10.1001/jama.2016.18663. doi: 10.1001/jama.2016.18663 URL pmid: 28030701
[4]	Vather R, Trivedi S, Bissett I. Defining postoperative ileus: results of a systematic review and global survey[J]. J Gastrointest Surg, 2013,17(5):962-972. doi: 10.1007/s11605-013-2148-y. doi: 10.1007/s11605-013-2148-y URL
[5]	Behm B, Stollman N. Postoperative ileus: etiologies and interventions[J]. Clin Gastroenterol Hepatol, 2003,1(2):71-80. doi: 10.1053/cgh.2003.50012. doi: 10.1053/cgh.2003.50012 URL pmid: 15017498
[6]	Doorly MG, Senagore AJ. Pathogenesis and clinical and economic consequences of postoperative ileus[J]. Surg Clin North Am, 2012, 92(2):259-272, viii. doi:10.1016/j.suc.2012.01.010. doi: 10.1016/j.suc.2012.01.010 URL pmid: 22414412
[7]	Izbizky GH, Minig L, Sebastiani MA, et al. The effect of early versus delayed postcaesarean feeding on women′s satisfaction: a randomised controlled trial[J]. BJOG, 2008,115(3):332-338. doi: 10.1111/j.1471-0528.2007.01591.x. doi: 10.1111/j.1471-0528.2007.01591.x URL pmid: 18190369
[8]	Kovavisarach E, Atthakorn M. Early versus delayed oral feeding after cesarean delivery[J]. Int J Gynaecol Obstet, 2005,90(1):31-34. doi: 10.1016/j.ijgo.2005.03.017. doi: 10.1016/j.ijgo.2005.03.017 URL pmid: 15923005
[9]	Kafali H, Duvan CI, Gözdemir E, et al. Influence of gum chewing on postoperative bowel activity after cesarean section[J]. Gynecol Obstet Invest, 2010,69(2):84-87. doi: 10.1159/000260048. doi: 10.1159/000260048 URL pmid: 19940484
[10]	Abd-El-Maeboud KH, Ibrahim MI, Shalaby DA, et al. Gum chewing stimulates early return of bowel motility after caesarean section[J]. BJOG, 2009,116(10):1334-1339. doi: 10.1111/j.1471-0528.2009.02225.x. doi: 10.1111/j.1471-0528.2009.02225.x URL pmid: 19523094
[11]	Shang H, Yang Y, Tong X, et al. Gum chewing slightly enhances early recovery from postoperative ileus after cesarean section: results of a prospective, randomized, controlled trial[J]. Am J Perinatol, 2010,27(5):387-391. doi: 10.1055/s-0029-1243313. doi: 10.1055/s-0029-1243313 URL pmid: 20013603
[12]	Ledari FM, Barat S, Delavar MA. Chewing gums has stimulatory effects on bowel function in patients undergoing cesarean section: a randomized controlled trial[J]. Bosn J Basic Med Sci, 2012,12(4):265-268. doi: 10.17305/bjbms.2012.2452. URL pmid: 23198943
[13]	Zamora BBB, Kalalo RE. Gum chewing versus traditional feeding on the early return of bowel motility after cesarean delivery:A prospective randomized controlled trial[J]. I nt J Gynecol Obstet, 2012,119(Suppl 3):S525. doi: 10.1016/S0020-7292(12)61182-5.
[14]	Jakkaew B, Charoenkwan K. Effects of gum chewing on recovery of bowel function following cesarean section: a randomized controlled trial[J]. Arch Gynecol Obstet, 2013,288(2):255-260. doi: 10.1007/s00404-013-2727-x. doi: 10.1007/s00404-013-2727-x URL
[15]	Rashad WA. Effect of sugarless gum chewing on intestinal movement after cesarean section[J]. Life Sci J, 2013,10(4):3257-3261.
[16]	Mohsenzadeh Ledari F, Barat S, Delavar MA, et al. Chewing sugar-free gum reduces ileus after cesarean section in nulliparous women: a randomized clinical trial[J]. Iran Red Crescent Med J, 2013,15(4):330-334. doi: 10.5812/ircmj.6458. doi: 10.5812/ircmj.6458 URL pmid: 24083008
[17]	Ajuzieogu OV, Amucheazi A, Ezike HA, et al. The efficacy of chewing gum on postoperative ileus following cesarean section in Enugu, South East Nigeria: A randomized controlled clinical trial[J]. Niger J Clin Pract, 2014,17(6):739-742. doi: 10.4103/1119-3077.144388. doi: 10.4103/1119-3077.144388 URL
[18]	Lee JT, Hsieh MH, Cheng PJ, et al. The Role of Xylitol Gum Chewing in Restoring Postoperative Bowel Activity After Cesarean Section[J]. Biol Res Nurs, 2016,18(2):167-172. doi: 10.1177/1099800415592966. doi: 10.1177/1099800415592966 URL pmid: 26156002
[19]	Göymen A, Şimşek Y, Özkaplan E, et al. Effect of Gum Chewing and Coffee Consumption on Intestinal Motility in Caesarean Sections[J]. J Clin Anal Med, 2017,8(5):411-415. doi: 10.4328/JCAM.4901.
[20]	Altraigey A, Ellaithy M, Atia H, et al. The effect of gum chewing on the return of bowel motility after planned cesarean delivery: a randomized controlled trial[J]. J Matern Fetal Neonatal Med, 2020,33(10):1670-1677. doi: 10.1080/14767058.2018.1526913. doi: 10.1080/14767058.2018.1526913 URL pmid: 30231787
[21]	Esfehani RJ, Yazd MM, Rsfehani AJ, et al. Effect of Chewing Gum on Post Cesarean Ileus in the North East of Iran: A Randomized Clinical Trial[J]. J Midwifery Reprod Health, 2018,6(3):1348-1355. doi: 10.22038/JMRH.2018.20694.1219.
[22]	Ahmed MR, Sayed Ahmed WA, Khamess RE, et al. Efficacy of three different regimens in recovery of bowel function following elective cesarean section: a randomized trial[J]. J Perinat Med, 2018,46(7):786-790. doi: 10.1515/jpm-2017-0389. doi: 10.1515/jpm-2017-0389 URL pmid: 29451863
[23]	Akalpler O, Okumus H. Gum chewing and bowel function after Caesarean section under spinal anesthesia[J]. Pak J Med Sci, 2018,34(5):1242-1247. doi: 10.12669/pjms.345.15772. doi: 10.12669/pjms.345.15772 URL pmid: 30344584
[24]	Najdi N, Kamali A, Eslami P. Comparison of the effect of misoprostol and chewing gum on intestinal movements after cesarean delivery[J]. Gastroenterol Ins, 2018,9(1):7608. doi: 10.4081/gi.2018.7608.
[25]	Ali A, Saeed S, Memon AS, et al. Chewing Aid in Routine Postoperative Orders-Does it reduce Postoperative Ileus after Cesarean Section? A Randomized Control Trial[J]. J Liaquat Uni Med Health Sci, 2019,18(2):109-212. doi: 10.22442/jlumhs. URL
[26]	Yenigul NN, Aydogan Mathyk B, Aslan Cetin B, et al. Efficacy of chewing gum for improving bowel function after cesarean sections: a randomized controlled trial[J]. J Matern Fetal Neonatal Med, 2020,33(11):1840-1845. doi: 10.1080/14767058.2018.1531122. doi: 10.1080/14767058.2018.1531122 URL pmid: 30606082
[27]	Sagili H, Rajangam G, Elamurugan TK. Effect of chewing gum on bowel recovery following cesarean section-a randomized controlled trial[J]. Int J Gynecol and Obstet, 2018,143(Supplement 3):237.
[28]	Safdari Dehcheshmeh F, Salehian T, Ganji F, et al. The Effect of Chewing Sugar Free Gum after Elective Cesarean-Delivery on Return of Bowel Function in Primiparous Women:[J]. Qom Univ Med Sci J, 2011,4(4):16-20.
[29]	Sahin E, Terzioglu F. The Effect of Gum Chewing, Early Oral Hydration, and Early Mobilization on Intestinal Motility After Cesarean Birth[J]. Worldviews Evid Based Nurs, 2015,12(6):380-388. doi: 10.1111/wvn.12125. doi: 10.1111/wvn.12125 URL pmid: 26613392
[30]	黄忠怡, 张芝银, 樊小庆. 咀嚼木糖醇口香糖对剖宫产术后胃肠道功能恢复的作用[J]. 中国乡村医药, 2017,24(21):15-16. doi: 10.3969/j.issn.1006-5180.2017.21.009.
[31]	梁俊华, 高阗, 韩巍巍, 等. 咀嚼口香糖促进剖宫产术后胃肠动力恢复的临床观察[J]. 同济大学学报(医学版), 2007,28(2):81-83. doi: 10.3969/j.issn.1008-0392.2007.02.021.
[32]	罗仕琴, 伍春兰, 杨小梅, 等. 剖宫产术后咀嚼口香糖对促进胃肠功能恢复的效果[J]. 中华现代护理杂志, 2010,16(24):2948-2949. doi: 10.3760/cma.j.issn.1674-2907.2010.24.044.
[33]	王佩红. 剖宫产术后早期咀嚼口香糖对产妇胃肠功能的影响[J]. 中国乡村医药, 2018,25(6):7-8. doi: 10.3969/j.issn.1006-5180.2018.06.003.
[34]	王幸, 任彦, 秦晓云, 等. 假饲对剖宫产术后胃动素及排气时间的影响[J]. 护理研究, 2011,25(8):682-683. doi: 10.3969/j.issn.1009-6493.2011.08.012.
[35]	梁世芳, 毛莹, 江宇, 等. 产妇剖宫产术后咀嚼口香糖对胃肠道的影响[J]. 中国卫生标准管理, 2018,9(23):176-177. doi: 10.3969/j.issn.1674-9316.2018.23.078.
[36]	王枭杰, 池畔. 咀嚼口香糖促进结直肠疾病术后肠道功能恢复的Meta分析[J]. 中华胃肠外科杂志, 2013,16(11):1078-1083. doi: 10.3760/cma.j.issn.1671-0274.2013.11.014.
[37]	李威, 刘念, 张士泰, 等. 妇科恶性肿瘤经腹手术术后咀嚼口香糖对胃肠功能恢复的影响[J]. 中华肿瘤防治杂志, 2016,23(3):198-202.
[38]	袁远霞, 赵红利, 何佳, 等. 剖宫产术后咀嚼口香糖促进肠道功能恢复的系统评价[J]. 中国循证医学杂志, 2011,11(4):427-432. doi: 10.3969/j.issn.1672-2531.2011.04.013.
[39]	Liu YF, Chen KB, Lin HL, et al. Comparison of the effect of epidural and intravenous patient-controlled analgesia on bowel activity after cesarean section: a retrospective study of 726 Chinese patients[J]. Acta Anaesthesiol Taiwan, 2009,47(1):22-27. doi: 10.1016/S1875-4597(09)60016-3. doi: 10.1016/S1875-4597(09)60016-3 URL pmid: 19318296
[40]	贺晓红. 剖宫产术后肠梗阻十例临床分析[J]. 中国药物与临床, 2020,20(4):620-621. doi: 10.11655/zgywylc2020.04.060.
[41]	赵雪琴, 周秀梅, 罗洁贤, 等. 咀嚼口香糖对剖宫产术后减轻腹胀的有效率分析[J]. 中国处方药, 2019,17(10):147-148. doi: 10.3969/j.issn.1671-945X.2019.10.088.
[42]	朱大年. 生理学[M]. 9版. 北京: 人民卫生出版社, 2018: 8.
[43]	Huang HP, He M. Usefulness of chewing gum for recovering intestinal function after cesarean delivery: A systematic review and meta-analysis of randomized controlled trials[J]. Taiwan J Obstet Gynecol, 2015,54(2):116-121. doi: 10.1016/j.tjog.2014.10.004. doi: 10.1016/j.tjog.2014.10.004 URL pmid: 25951713
[44]	Craciunas L, Sajid MS, mAhmed AS . Chewing gum in preventing postoperative ileus in women undergoing caesarean section: a systematic review and meta-analysis of randomised controlled trials[J]. BJOG, 2014,121(7):793-799;discussion 799. doi: 10.1111/1471-0528.12696. doi: 10.1111/1471-0528.12696 URL pmid: 24628729
[45]	Wen Z, Shen M, Wu C, et al. Chewing gum for intestinal function recovery after caesarean section: a systematic review and meta-analysis[J]. BMC Pregnancy Childbirth, 2017,17(1):105. doi: 10.1186/s12884-017-1286-8. doi: 10.1186/s12884-017-1286-8 URL pmid: 28415967
[46]	Tandeter H. Hypojournal: hexitols in chewing gum may play a role in reducing postoperative ileus[J]. Med Hypotheses, 2009,72(1):39-40. doi: 10.1016/j.mehy.2008.06.044. doi: 10.1016/j.mehy.2008.06.044 URL
[47]	高茜, 李华坤, 黄海涛, 等. 两种不同类型口香糖对口腔微环境的影响比较[J]. 牙体牙髓牙周病学杂志, 2016,26(10):607-611. doi: 10.15956/j.cnki.chin.j.conserv.dent.2016.10.006.

作者	年份	国家	样本量（试验组/对照组）	干预措施	对照组	结局指标
Kafali等^[9]	2010	土耳其	74/76	术后2 h开始,3次/d,首次15 min,以后至少1 h	平行对照	①②⑦
Abd-EI-Maeboud等^[10]	2009	埃及	93/107	白天每2 h一次、每次15 min,直到首次排气为止	平行对照	①②⑤⑥⑦
Shang等^[11]	2010	中国	195/191	手术室返回病房后开始,3次/d,每次30 min,直到首次排便为止	平行对照	①②⑤⑥⑦
Ledari等^[12]	2012	伊朗	50/50	术后6 h开始,3次/d,每次至少1 h,直到出院为止	平行对照	①②③④⑦
Zamora等^[13]	2012	菲律宾	18/35	术后12 h咀嚼2粒口香糖15 min	平行对照	②⑦
Jakkaew等^[14]	2013	泰国	25/25	术后恢复意识开始,4次/d,每次30 min,直到第一次通气为止	平行对照	②④⑦
Rashad等^[15]	2013	埃及	30/30	术后返回病房后开始,3次/d,每次30 min,直至出院为止	平行对照	①②③⑤
Mohsenzadeh Ledari等^[16]	2013	伊朗	30/30	术后6 h开始,3次/d,每次1 h,直到出院为止	平行对照	②③④⑤
Ajuzieogu等^[17]	2014	尼日利亚	90/90	术后6 h开始,3次/d,每次30 min,直到首次排气为止	平行对照	①②③⑦
Lee等^[18]	2016	中国	40/40	术后2 h开始,每2 h一次（上午9点到晚上8点）,每次15 min, 直到第一次通气为止	平行对照	①②③
G?ymen等^[19]	2017	土耳其	25/25	术后2 h开始,每4 h一次,直到排便为止	平行对照	②③⑤
Altraigey等^[20]	2018	沙特阿拉伯	100/100	术后2 h开始,每4 h一次,每次30 min,直到排便为止	平行对照	①②⑤⑦
Esfehani等^[21]	2018	伊朗	35/58	术后6、12、18、24 h咀嚼口香糖	平行对照	①②③⑦
Ahmed等^[22]	2018	埃及	100/100	术后2 h开始,每2 h一次,每次15 min,直到排气为止	平行对照	①②③⑦
Akalpler等^[23]	2018	土耳其	45/45	术后2 h开始,每2 h一次,每次15~30 min,直到排气为止	平行对照	①②⑦
Najdi等^[24]	2018	伊朗	108/108	术后2 h开始,24 h内3次	平行对照	①②③⑦
Ali等^[25]	2019	巴基斯坦	109/109	术后6 h开始,3次/d,每次15~30 min,直到排气为止	平行对照	②③④
Yenigul等^[26]	2019	土耳其	75/75	术后3、5、7 h咀嚼口香糖,每次30 min	平行对照	①②③⑤⑦
Sagili等^[27]	2018	印度	85/85	术后6 h开始,3次/d,每次30 min,直至排气为止	平行对照	②③⑦
Safdari等^[28]	2011	伊朗	60/60	麻醉苏醒后开始,4次/d,直至排气或排便时为止	平行对照	①②③⑤⑦
Sahin等^[29]	2015	土耳其	30/30	术后2 h开始,每2 h一次,每次15 min,夜间不咀嚼,直到开始肠运动和排气为止	平行对照	①②⑤⑦
黄忠怡等^[30]	2017	中国	46/46	术后2 h开始咀嚼口香糖2粒,每3 h一次,4次/d,每次15 min,夜间停止,直到肛门首次排气为止	平行对照	①②③
梁俊华等^[31]	2007	中国	60/60	返回病房后开始,每2 h一次,每次15 min,共3次	平行对照	②③
罗仕琴等^[32]	2010	中国	150/150	术后2 h开始,3次/d,每次30 min,直到肛门排气顺畅为止	平行对照	①②③
王佩红^[33]	2018	中国	110/100	术后2 h开始予口香糖2~4片,4次/d,每次约15 min	平行对照	①②③
王幸等^[34]	2011	中国	150/150	术后2 h开始,每2 h一次,每次15 min,夜间不咀嚼	平行对照	①②
梁世芳等^[35]	2018	中国	50/50	术后2 h开始,3次/d,每次30 min,直到肛门排气顺畅为止	平行对照	③⑥

作者	年份	国家	样本量（试验组/对照组）	干预措施	对照组	结局指标
Kafali等^[9]	2010	土耳其	74/76	术后2 h开始,3次/d,首次15 min,以后至少1 h	平行对照	①②⑦
Abd-EI-Maeboud等^[10]	2009	埃及	93/107	白天每2 h一次、每次15 min,直到首次排气为止	平行对照	①②⑤⑥⑦
Shang等^[11]	2010	中国	195/191	手术室返回病房后开始,3次/d,每次30 min,直到首次排便为止	平行对照	①②⑤⑥⑦
Ledari等^[12]	2012	伊朗	50/50	术后6 h开始,3次/d,每次至少1 h,直到出院为止	平行对照	①②③④⑦
Zamora等^[13]	2012	菲律宾	18/35	术后12 h咀嚼2粒口香糖15 min	平行对照	②⑦
Jakkaew等^[14]	2013	泰国	25/25	术后恢复意识开始,4次/d,每次30 min,直到第一次通气为止	平行对照	②④⑦
Rashad等^[15]	2013	埃及	30/30	术后返回病房后开始,3次/d,每次30 min,直至出院为止	平行对照	①②③⑤
Mohsenzadeh Ledari等^[16]	2013	伊朗	30/30	术后6 h开始,3次/d,每次1 h,直到出院为止	平行对照	②③④⑤
Ajuzieogu等^[17]	2014	尼日利亚	90/90	术后6 h开始,3次/d,每次30 min,直到首次排气为止	平行对照	①②③⑦
Lee等^[18]	2016	中国	40/40	术后2 h开始,每2 h一次（上午9点到晚上8点）,每次15 min, 直到第一次通气为止	平行对照	①②③
G?ymen等^[19]	2017	土耳其	25/25	术后2 h开始,每4 h一次,直到排便为止	平行对照	②③⑤
Altraigey等^[20]	2018	沙特阿拉伯	100/100	术后2 h开始,每4 h一次,每次30 min,直到排便为止	平行对照	①②⑤⑦
Esfehani等^[21]	2018	伊朗	35/58	术后6、12、18、24 h咀嚼口香糖	平行对照	①②③⑦
Ahmed等^[22]	2018	埃及	100/100	术后2 h开始,每2 h一次,每次15 min,直到排气为止	平行对照	①②③⑦
Akalpler等^[23]	2018	土耳其	45/45	术后2 h开始,每2 h一次,每次15~30 min,直到排气为止	平行对照	①②⑦
Najdi等^[24]	2018	伊朗	108/108	术后2 h开始,24 h内3次	平行对照	①②③⑦
Ali等^[25]	2019	巴基斯坦	109/109	术后6 h开始,3次/d,每次15~30 min,直到排气为止	平行对照	②③④
Yenigul等^[26]	2019	土耳其	75/75	术后3、5、7 h咀嚼口香糖,每次30 min	平行对照	①②③⑤⑦
Sagili等^[27]	2018	印度	85/85	术后6 h开始,3次/d,每次30 min,直至排气为止	平行对照	②③⑦
Safdari等^[28]	2011	伊朗	60/60	麻醉苏醒后开始,4次/d,直至排气或排便时为止	平行对照	①②③⑤⑦
Sahin等^[29]	2015	土耳其	30/30	术后2 h开始,每2 h一次,每次15 min,夜间不咀嚼,直到开始肠运动和排气为止	平行对照	①②⑤⑦
黄忠怡等^[30]	2017	中国	46/46	术后2 h开始咀嚼口香糖2粒,每3 h一次,4次/d,每次15 min,夜间停止,直到肛门首次排气为止	平行对照	①②③
梁俊华等^[31]	2007	中国	60/60	返回病房后开始,每2 h一次,每次15 min,共3次	平行对照	②③
罗仕琴等^[32]	2010	中国	150/150	术后2 h开始,3次/d,每次30 min,直到肛门排气顺畅为止	平行对照	①②③
王佩红^[33]	2018	中国	110/100	术后2 h开始予口香糖2~4片,4次/d,每次约15 min	平行对照	①②③
王幸等^[34]	2011	中国	150/150	术后2 h开始,每2 h一次,每次15 min,夜间不咀嚼	平行对照	①②
梁世芳等^[35]	2018	中国	50/50	术后2 h开始,3次/d,每次30 min,直到肛门排气顺畅为止	平行对照	③⑥