摘要
目的系统评价全胃肠外营养(TPN)和全肠内营养(TEN)对重症急性胰腺炎(SAP)患者预后的影响及其安全性。方法计算机检索PubMed(1996～2011.6)、EMbase(1984～2011.6)、Cochrane Central Registerof Controlled Trials(Cochrane Library,2011年第6期)、CBM(1978～2011.6),并补充检索纳入研究的参考文献;在对纳入研究进行资料提取及质量评估后,采用RevMan 5.1软件进行分析。结果共纳入7个RCT,合计379例患者。Meta分析结果显示:与TPN相比,TEN可降低SAP患者的病死率[RR=0.33,95%CI(0.20,0.55),P<0.000 1]、胰腺感染[RR=0.35,95%C(I0.25,0.50),P<0.000 01]及需要手术干预的机率[RR=0.43,95%C(I0.23,0.82),P=0.01],同时减少多器官衰竭(MOF)的发生[RR=0.28,95%CI(0.17,0.46),P<0.000 01],但两者营养措施相关并发症的发生率无差异[RR=1.16,95%CI(0.42,3.22),P=0.78]。结论目前研究提示,对SAP患者进行营养支持,与TPN比较,TEN可以降低病死率、减少胰腺感染及需要手术干预的机率,降低MOF的发生,而并未增加其营养措施相关并发症,因此,若条件允许应尽可能及早选择TEN进行营养支持。
Objective To evaluate the effectiveness and safety of total enteral nutrition（TEN） versus total parenteral nutrition（TPN） in patients with severe acute pancreatitis（SAP）.Methods The databases such as Pubmed（1996 to June 2011）,EMbase（1984 to June 2011）,Cochrane Central Register of Controlled Trials of The Cochrane Library（Issue 6,2011） and CBM（1978 to June 2011） were electronically searched,and the relevant references of the included papers were also manually searched.Two reviewers independently screened the trials according to inclusion and exclusion criteria,extracted the data,and assessed the methodology quality.Meta-analyses were performed using the Cochrane Collaboration＇s RevMan 5.1 software.Results Seven randomized controlled trials（RCTs） involving 379 patients with SAP were included.The results of meta-analyses showed that compared with TPN,TEN could significantly reduce the risk of mortality（RR=0.33,95%CI 0.20 to 0.55,P〈0.0001）,pancreatitis-related infections（RR=0.35,95%CI 0.25 to 0.50,P〈0.00001）,required rate of surgical intervention（RR=0.43,95%CI 0.23 to 0.82,P=0.01）,and incidence of multiple organ failure（MOF）（RR=0.28,95%CI 0.17 to 0.46,P〈0.000？01）.There was no significant difference in the nutrition strategies associated complications between TPN and TEN（RR=1.16,95%CI 0.42 to 3.22,P=0.78）.Conclusion Meta-analyses show that compared with TPN,TEN can reduce the risk of mortality,pancreatitis-related infections,required rate of surgical intervention,and incidence of MOF;and it will not increase the nutrition strategies associated complications.Consequently,TEN should be considered a better choice for SAP patients as early as possible.
出处
《中国循证医学杂志》
CSCD
2011年第11期1295-1301,共7页
Chinese Journal of Evidence-based Medicine
关键词
重症急性胰腺炎
全胃肠外营养
肠内营养
META分析
系统评价
随机对照试验
Severe acute pancreatitis
Total parenteral nutrition
Enteral nutrition
Meta-analysis
Systematic review
Randomized controlled trial
