摘要
目的分析肠内营养(EN)及肠外营养(PN)2种营养方式在重症急性胰腺炎(SAP)治疗中的临床效果,以期为临床决策提供依据。方法检索中国知网、PubMed、Medline、万方中文期刊全文数据库及维普数据库关于不同的营养支持策略(EN和PN)对SAP患者疗效分析的相关文献,检索时间为2010年1月-2020年1月。由2名评价员对文献进行质量评价,意见不统一时通过讨论解决或由第3者协助判定。采用RvMan 5.3对纳入研究进行Meta分析。结果共纳入12项研究,811例研究对象,其中EN组406例,PN组405例。相比PN组,EN组可明显降低SAP患者死亡率(OR=0.37,95%CI为0.21~0.66,P<0.01)、多器官功能障碍综合征(MODS)发生率(OR=0.19,95%CI为0.08~0.43,P<0.01)、总感染率(OR=0.17,95%CI为0.11~0.28,P<0.01)及胰周感染率(OR=0.72,95%CI为0.36~1.47,P=0.37);治疗2周后,可降低白细胞计数(WMD=-4.29,95%CI为-4.86~-3.72,P<0.01)、改善白蛋白水平(WMD=5.79,95%CI为5.10~6.48,P<0.01)、改善急性生理与慢性健康(APACHE-Ⅱ)评分(WMD=-3.05,95%CI为-3.26~-2.84,P<0.01)及X射线计算机断层摄影(CT)评分(WMD=-3.91,95%CI为-5.13~-2.69,P<0.01);缩短患者总住院时间(WMD=-8.71,95%CI为-9.50~-7.19,P<0.01)并减少总住院总费用(WMD=-1.97,95%CI为-2.13~-1.81,P<0.01)。结论与PN组相比,EN组可明显降低SAP患者死亡率、感染率、MODS发生率、总住院时间及住院费用,改善APACHE-Ⅱ评分及CT评分,且在炎症恢复及营养状态恢复方面明显优于PN。故无EN禁忌证时,首先选择EN。
Objective To analyze the clinical treatment effects of two nutrition modalities,enteral nutrition(EN)and parenteral nutrition(PN),in the treatment of severe acute pancreatitis(SAP),in order to provide a basis for clinical decisionmaking.Methods Relevant literatures on the analysis of the efficacy of different nutritional support strategies(EN and PN)in patients with SAP were retrieved from China Knowledge Network,PubMed,Medline,VIP Data base,and Wanfang Chinese journal full-text database,and the quality of the literatures was evaluated by two evaluators,and disagreements were resolved by discussion or judged by a third party.The retrieval time was from January 2010 to January 2020.The Meta-analysis of the included studies was performed using RvMan 5.3 software.Results A total of 12 randomized controlled trials were included in this study,with a total of 811 subjects,of which 406 were in the EN group and 405 in the PN group.Compared with PN,the EN group significantly reduced the mortality rate(OR=0.37,95%CI:0.21-0.66,P<0.01),multiple organ dysfunction syndrome(MODS)incidence(OR=0.19,95%CI:0.08-0.43,P<0.01),total infection rate(OR=0.17,95%CI:0.11-0.28,P<0.01),peripancreatic infection rate(OR=0.72,95%CI:0.36-1.47,P=0.37),reduced leukocyte count after 2 weeks of treatment(WMD=-4.29,95%CI:-4.86--3.72,P<0.01),improved albumin level after 2 weeks(WMD=5.79,95%CI:5.10-6.48,P<0.01),improved APACHE-Ⅱscore(WMD=-3.05,95%CI:-3.26--2.84,P<0.01)and computerized tomography(CT)score(WMD=-3.91,95%CI:-5.13--2.69,P<0.01),shortened total hospital stay(WMD=-8.71,95%CI:-9.50--7.19,P<0.01),and reduced total hospitalization cost(WMD=-1.97,95%CI:-2.13--1.81,P<0.01).Conclusions Compared with PN,EN can significantly reduce mortality rate,infection rate,MODS incidence,total hospital stay and hospital costs,improve APACHE-II score and CT score in SAP patients,and is significantly better than PN in terms of inflammation recovery and nutrition status recovery.Therefore,when there is no contraindication to EN,EN is chosen first.
作者
田晓
陈振华
TIAN Xiao;CHEN Zhen-hua(Graduate School of Shandong First Medical University,Taian 271000,China;Department of Gastroenterology,Second Affiliated Hospital of Shandong First Medical University,Taian 271000,China)
出处
《社区医学杂志》
CAS
2021年第12期767-773,共7页
Journal Of Community Medicine
关键词
重症急性胰腺炎
肠内营养
肠外营养
Meta分析
severe acute pancreatitis
enteral nutrition
parenteral nutrition
Meta-analysis
