摘要
目的:针对早期肠内营养(EEN)对脓毒症及脓毒性休克病人的临床治疗效果进行系统评价。方法:通过计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data、VIP数据库收集EEN治疗成人脓毒症或脓毒性休克病人的随机对照试验(RCT)研究,检索时限均从建库至2021年7月。由两位研究员背对背独立进行文献筛选、质量评价以及资料的提取,采用RevMan 5.3软件进行Meta分析。结果:最终纳入12篇RCT,共包括644例病人。Meta分析结果显示,与入院48 h后延迟给予肠内营养或入院后给予肠外营养相比,入院48 h以内给予EEN对病人的28 d死亡率(RR=0.98,95%CI:0.62~1.54,P=0.92)没有显著影响,而EEN组病人的ICU住院时间(MD=-4.08,95%CI:-4.67~-3.49,P<0.00001)和机械通气时间(MD=-2.09,95%CI:-2.78~-1.40,P<0.00001)明显缩短,多器官功能障碍综合征(MODS)发生率(RR=0.42,95%CI:0.24~0.73,P=0.002)明显降低,并且经治疗后,EEN组病人的序贯器官衰竭(SOFA)评分(MD=-1.63,95%CI:-2.59~-0.67,P=0.0009)、降钙素原(PCT)(SMD=-1.57,95%CI:-2.86~-0.28,P=0.02)及C反应蛋白(CRP)水平(SMD=-1.60,95%CI:-2.23~-0.96,P<0.00001)均明显降低;两组病人肾脏连续性替代治疗(CRRT)的发生率(RR=0.90,95%CI:0.33~2.47,P=0.84)没有统计学差异。结论:当前证据显示,入院48 h内给予EEN对脓毒症及脓毒性休克病人的28 d死亡率及CRRT发生率没有影响,但是能降低病人的MODS发生率,缩短ICU住院时间和机械通气时间,降低SOFA评分和炎症指标PCT、CRP的水平。由于受到纳入研究数量和质量的限制,上述结论仍需开展更多高质量研究予以验证。
Objective:To systematically review the clinical efficacy of early enteral nutrition on patients with sepsis and septic shock.Methods:PubMed,EMbase,The Cochrane Library,CNKI,WanFang Data and VIP databases were electronically searched to collect randomized controlled trials(RCT)on early enteral nutrition support in adult patients with sepsis or septic shock from inception to July 2021.Two reviewers selected literature,assessed risk of bias and collected data independently,the RevMan 5.3 software was used to perform meta-analysis.Results:A total of 12articles were included,including 644 patients.The results of meta-analysis showed that:Compared with patients who were given enteral nutrition 48 hours after admission or given parenteral nutrition after admission,there was no statistical difference in 28-day mortality(RR=0.98,95%CI:0.62~1.54,P=0.92),but the lengths of ICU stay(MD=-4.08,95%CI:-4.67~-3.49,P<0.00001)and duration of mechanical ventilation[MD=-2.09,95%CI(-2.78,-1.40),P<0.00001]in patients receiving early enteral nutrition within 48 hours after admission were significantly shortened,and the incidence of multiple organ dysfunction syndrome(MODS)(RR=0.42,95%CI:0.24~0.73,P=0.002)was significantly reduced,after treatment,the sequential organ failure assessment(SOFA)of patients(MD=-1.63,95%CI:-2.59~-0.67,P=0.0009),level of procalcitonin(PCT)(SMD=-1.57,95%CI:-2.86~-0.28,P=0.02)and C-reactive protein(CRP)(SMD=-1.60,95%CI:-2.23~-0.96,P<0.00001)were obviously decreased in the group of early enteral nutrition;there was no statistical difference in the incidence of continuous renal replacement therapy(CRRT)(RR=0.90,95%CI:0.33~2.47,P=0.84)between the two groups.Conclusions:Current evidence shows that early enteral nutrition within 48 hours after admission has no effect on 28-day mortality and CRRT incidence,but can reduce the incidence of MODS,shorten the lengths of ICU stay and duration of mechanical ventilation,and reduce the SOFA score and the levels of inflammation indicators in patients with sepsis and septic shock
作者
李晗
田李均
徐俊贤
张晴晴
韩旭东
LI Han;TIAN Li-jun;XU Jun-xian;ZHANG Qing-qing;HAN Xu-dong(Department of Critical Care Medicine,Nantong Third People's Hospital,Nantong University,Nantong 226000,Jiangsu,China)
出处
《肠外与肠内营养》
CAS
CSCD
北大核心
2022年第1期35-40,45,共7页
Parenteral & Enteral Nutrition
基金
江苏省南通市卫健委市级重点学科支持项目(wx2017002)
南通市科技计划项目(JC2020054,MSZ21030)
南通市卫健委科研课题(MA2020017,MB2020036)。
