摘要
目的评价早期肠内营养支持和延迟肠内营养支持对重症脑损伤患者营养状况及感染并发症的影响.方法检索1989-2017年的中国生物医学文献数据库(CBM)、CNKI、万方数据知识服务平台、中国维普全文数据库(VIP)、Cochrane图书馆、Web of Science、PubMed、EMbase中有关早期肠内营养支持和延迟肠内营养支持对重症脑损伤患者营养状况及感染并发症影响的随机对照试验文献.采用Cochrane-Handbook 5.0手册的质量评价方法评价文献质量,检验纳入文献异质性.采用固定效应模型或随机效应模型合并效应量.结果共纳入10篇随机对照试验.Meta分析结果证实,早期肠内营养支持与延迟肠内营养支持相比,能提高患者血清总蛋白、白蛋白水平和外周淋巴细胞计数(Z值分别为10.20、4.23、5.24;P<0.01),减少颅脑损伤患者肺部感染、颅脑感染的发生率(Z值分别为4.12、2.15;P<0.05),但对颅脑损伤患者上消化道出血的发生率发生无影响(Z=0.82,P=0.41).结论早期肠内营养支持(患者入院48 h内)与延迟肠内营养支持(患者入院48 h后)相比,能有效提高重症颅脑损伤患者的血清总蛋白、白蛋白,改善患者营养状况,并能提高患者外周淋巴细胞计数,提高患者抵抗力,降低患者颅脑感染、肺部感染的发生.因此,重症颅脑损伤患者如无禁忌,均应早期进行肠内营养支持.
Objective To evaluate the impacts of early enteral nutrition(EEN)support and delayed enteral nutrition(DEN)support in the nutritional status and infection complications in patients with severe traumatic brain injury.Methods The articles of randomized controlled trials about EEN support and DEN support on the nutritional status and infection complications in patients with severe traumatic brain injury were searched in CBMdisc,CNKI,Wanfang Data,VIP,Cochrane Library,Web of Science,PubMed,EMbase from 1990 to 2017.The quality evaluation method in Cochrane-Handbook5.0 handbook was adopted to evaluate the quality of articles and test the heterogeneity of the included articles.Fixed-effect model or random-effect model were used to merge the effects.Results A total of 10 randomized controlled trials were included.Meta-analysis results proved that,compared with DEN support,EEN support can increase the level of serum total protein,albumin and peripheral lymphocyte count(Z=10.20,4.23,5.24;P<0.01)and reduce the incidence of pulmonary infection and craniocerebral infection in patients with craniocerebral injury(Z=4.12,2.15;P<0.05),but it has no effect on the incidence of upper gastrointestinal hemorrhage in patients with craniocerebral injury(Z=0.82,P=0.41).Conclusions Compared with DEN support(within 48 hours of admission),EEN support(48 hours after admission)can effectively improve serum total protein and albumin,improve nutritional status,increase peripheral lymphocyte count,increase patient resistance and reduce the occurrence of cranial infection and pulmonary infection.Therefore,patients with severe craniocerebral injury should receive EEN support if there is no contraindication.
作者
史颜梅
张全城
赵红乐
吕梦
代玲玉
张淑香
Shi Yanmei;Zhang Quancheng;Zhao Hongle;Lyu Meng;Dai Lingyu;Zhang Shuxiang(GI Medicine,Shandong Provincial Qianfoshan Hospital,the First Hospital Affiliated with Shandong First Medical University,Ji'nan 250014,China;Intensive Care Unit,Shandong Provincial Qianfoshan Hospital,the First Hospital Affiliated with Shandong First Medical University,Ji'nan 250014,China;School of Nursing,Weifang Medical University,Weifang 261053,China;School of Nursing,Shandong University,Ji'nan 250014,China;Nursing Department,Shandong Provincial Qianfoshan Hospital,the First Hospital Affiliated with Shandong First Medical University,Ji'nan 250014,China)
出处
《中华现代护理杂志》
2019年第29期3765-3770,共6页
Chinese Journal of Modern Nursing
基金
山东省医药卫生科技发展计划项目(2017WS186,2017WSB04086)
山东省软科学研究计划(2017RKB14047)。
关键词
重症颅脑损伤
营养状况
感染
早期肠内营养
延迟肠内营养
META分析
Severe craniocerebral injury
Nutritional status
Infection
Early enteral nutrition
Delayed enteral nutrition
Meta-analysis
