摘要
目的对食管癌术后早期输注肠内营养(EN)或肠外营养(PN)的随机对照研究(RCT)进行Meta分析,进一步明确EN与PN对食管癌术后疗效的影响。方法计算机检索PubMed、Medline、EMbase、The Cochrane Library、Web of Science、中国知网、万方、维普数据库、中国生物医学文献数据库中关于食管癌术后早期输注EN或PN的RCT文献,检索时限为建库至2018年4月。根据纳入和排除标准,2名研究员独立筛选、评价文献。采用RevMan 5.3软件进行Meta分析。结果纳入30篇RCT文献,共3969例患者。Meta分析发现:在术后吻合口瘘发生率(I2=0%,OR=0.67,95%CI 0.45~0.99,P=0.04)、术后肺部感染发生率(I2=0%,OR=0.42,95%CI 0.32~0.55,P<0.0001)、术后白蛋白水平(I2=38%,MD=0.78,95%CI 0.51~1.06,P<0.00001)、术后首次肛门排气时间(I2=0%,MD=–23.16,95%CI–25.16~21.16,P<0.00001)、术后切口感染方面(I2=0%,RR=0.36,95%CI 0.21~0.64,P=0.0005),EN与PN差异有统计学意义。结论与PN相比,EN能显著降低术后主要并发症发生率、缩短术后首次肛门排气时间。此外,EN在改善营养状态、增加体重和降低费用方面优于PN,副反应少于PN。
Objective To compare the impact of early enteral nutrition(EN)and parenteral nutrition(PN)on the postoperative efficacy of esophageal cancer through meta-analysis of relevant randomized controlled trial(RCT).Methods PubMed,Medline,EMbase,The Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP,China Biology Medicine disc(CBMdisc)were searched by computer from inception to April 2018 to identify potential RCT which assessed clinical efficacy between EN and PN for postoperative patients with esophageal cancer.According to the inclusion and exclusion criteria,two researchers independently screened and evaluated literature.Meta-analysis was performed by RevMan 5.3 software.Results A total of 30 RCT studies were selected,including 3969 patients.Meta-analysis results showed that:there was a significant difference between EN and PN in postoperative anastomotic fistulas(I2=0%,OR=0.67,95%CI 0.45-0.99,P=0.04),postoperative pulmonary infections(I2=0%,OR=0.42,95%CI 0.32-0.55,P<0.0001),postoperative albumin levels(I2=38%,MD=0.78,95%CI 0.51-1.06,P<0.00001),time of first anal exhaust after operation(I2=0%,MD=–23.16,95%CI–25.16-21.16,P<0.00001)and postoperative incision infection(I2=0%,RR=0.36,95%CI 0.21-0.64,P=0.0005).Conclusion Compared with PN,early EN can significantly reduce the incidence of major postoperative complications and shorten the time of first anal exhaust after surgery.In addition,EN is superior to PN in improving nutritional status,increasing weight and reducing costs and side effects.
作者
刘晓青
高林春
周东
刘权兴
郑鸿
李静
LIU Xiaoqing;GAO Linchun;ZHOU Dong;LIU Quanxing;ZHENG Hong;LI Jing(Department of Thoracic Surgery,Xinqiao Hospital,Army Military Medical University,Chongqing,400037,P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2020年第11期1341-1347,共7页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
食管癌
肠内营养
并发症
系统分析/Meta分析
Esophageal cancer
enteral nutrition
complications
systematic reviews/meta-analysis
