肠内营养与肠外营养对危重症临床疗效的Meta分析

目的:通过Meta分析方法系统评价肠内营养(EN)与肠外营养(PN)对危重症的临床疗效。方法:检索Pub Med、Embase、Springerlink、Medline、中国知网、万方、维普数据库(建库至2016年4月22日),纳入有关肠内营养与肠外营养治疗的随机对照试验(RCT),以总并发症发生率、总感染率、肺炎发生率、尿路感染率、脓毒症及其他感染发病率、死亡率、住院时间等为效应指标,由两名研究者独立对入选文献的质量和研究结果进行摘录,应用Review Manager 5.3进行Meta分析。结果 :Meta分析结果显示,与肠外营养相比,肠内营养显著降低了总感染发生率(OR=0.54,P=0.04)、肺炎发生率(OR=0.65,P=0.04)及脓毒症及其他感染发生率(OR=0.59,P=0.04),两者在总并发症发生率、尿路感染率、死亡率及住院时间均无显著差异。结论 :肠内营养能显著降低危重症病人感染的发生,特别是降低肺炎、脓毒症及相关性炎症反应的发生。

A Meta-analysis of Clinical Efficacy for Enteral Nutrition vs Parenteral Nutrition in Critical illness

Objective:To systematically evaluate the clinical efficacy of enteral nutrition (EN) versus parenteral nutrition(PN) on critically ill patient.Methods:Randomized controlled trials (RCT) comparing EN and TPN were searched in PubMed、Embase、Springerlink、Medline、CNKI、CHINAINFO and Vip from the date of database foundation to April 22,2016.The total complications,the total incidence of infections,pneumonia incidence,urinary tract infection occurrences,sepsis and other infection incidence,mortality,length of hospital stay,etc were collected.The quality and result of admission data were extracted by two researchers independently.Software RevMan5.3 was used to conduct meta-analysis.Results:Comparing parenteral nutrition,the results of meta-analysis show that enteral nutrition can significantly reduce total incidence of infections (OR =0.54,P =0.04)、pneumonia incidence (OR =0.65,P =0.04),and sepsis and other infection incidence (OR =0.59,P =0.04).The total incidence of complications,urinary tract infection rate,mortality and hospitalization time had no significant difference between enteral nutrition and parenteral nutrition.Conclusion:Enteral nutrition can significantly reduce the complications of infection for critically ill patients,especially the incidence of pneumonia,sepsis and other inflammatory reactions.