摘要
目的通过系统评价方法探讨肠内营养(EN)不同滴注速度对重症急性胰腺炎(SAP)患者喂养耐受性及腹内压的影响。方法检索中国知网(CNKI)、万方数据库、维普中文科技期刊全文数据库(VIP)、美国国立医学图书馆PubMed数据库、Cochrane图书馆数据库、荷兰医学文摘EMbase数据库等中英文数据库,检索从建库至2022年7月发表的关于EN不同滴注速度对SAP喂养耐受性的随机对照试验(RCT),高速组初始滴注速度为30 mL/h、每4 h调节1次,每次增加20 mL,12 h后逐渐增加至80~90 mL进行持续性滴注直至当日总剂量;低速组初始滴注速度为30 mL/h、每4 h调节1次,每次增加10 mL,20~24 h后逐渐增加至80~90 mL进行持续性滴注直至当日总剂量。主要结局指标为EN不耐受发生情况及腹内压。由2名研究者独立筛选文献,并提取资料评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果最终纳入9项RCT,共633例SAP行EN支持的患者,其中低速组317例,高速组316例。纳入研究整体设计良好,质量较高。Meta分析结果显示,与高速组比较,低速组EN不耐受和腹泻、腹胀、呕吐反流、胃潴留发生率均明显降低〔不耐受发生率:优势比(OR)=0.13,95%可信区间(95%CI)为0.08~0.21,P<0.00001;腹泻发生率:OR=0.11,95%CI为0.04~0.25,P<0.00001;腹胀发生率:OR=0.13,95%CI为0.06~0.27,P<0.00001;呕吐反流发生率:OR=0.18,95%CI为0.08~0.40,P<0.00001;胃潴留发生率:OR=0.19,95%CI为0.08~0.43,P<0.00001〕,低速组治疗后8、16、20、24 h腹内压均明显降低〔治疗后8 h:标准化均数差(SMD)=-1.27,95%CI为-1.53~-1.00,P<0.00001;治疗后16 h:SMD=-3.29,95%CI为-3.67~-2.91,P<0.00001;治疗后20 h:SMD=-3.81,95%CI为-4.32~-3.29,P<0.00001;治疗后24 h:SMD=-4.53,95%CI为-5.12~-3.94,P<0.00001〕。结论采用低速滴注EN对于降低SAP患者喂养不耐受情况具有积极意义,胃肠功能恢复更快,值得临床推广。
Objective To explore the effects of different enteral nutrition(EN)infusion rates on feeding tolerance and intra-abdominal pressure in patients with severe acute pancreatitis(SAP)through systematic evaluation.Methods Search Chinese and English databases such as China National Knowledge Internet(CNKI),Wanfang database,Chinese Science and Technology Datebase(VIP),PubMed database of the National Medical Library of the United States,Cochrane Database,and EMbase Database of the Netherlands Medical Abstracts.From the establishment of the database to July 2022,the randomized controlled trial(RCT)on the feeding tolerance of EN at different infusion rate to SAP was published.The initial speed of the high-speed group was 30 mL/h,adjusted once every 4 hours,increased by 20 mL each time.After 12 hours,it gradually increased to 80-90 mL for continuous infusion until the total dose of the same day.The initial speed of the low-speed group was 30 mL/h,adjusted once every 4 hours,increased by 10 mL each time,after 20-24 hours,it gradually increased to 80-90 mL for continuous infusion until the total dose of the same day.The main outcome measures were EN intolerance and intra-abdominal pressure.After 2 researchers independently selected literature and extracted data to evaluate the risk of bias included in the study,a Metaanalysis was conducted using RevMan 5.4 software.Results Finally,9 RCT were included,including 633 patients,all of whom were SAP EN patients.Among them,there were 317 cases in the low-speed group and 316 cases in the high-speed group.The overall design of the included study is good and the quality is high.Meta-analysis showed that compared with the high-speed group,the low-speed group had significantly lower EN intolerance rate,diarrhea,abdominal distention,vomiting reflux and gastric retention rate[incidence of intolerance:odds ratio(OR)=0.13,95%confidence interval(95%CI)was 0.08-0.21,P<0.00001;incidence of diarrhea:OR=0.11,95%CI was 0.04-0.25,P<0.00001;incidence of abdominal distension:OR=0.13,95%CI was 0.06-0.
作者
程峰玉
程丽婷
杨贵霞
王勇
张伟
Cheng Fengyu;Cheng Liting;Yang Guixia;Wang Yong;Zhang Wei(Department of Intensive Care Medicine,Kweichow Moutai Hospital,Renhuai 564500,Guizhou,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2023年第4期446-452,共7页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
贵州省科技计划项目(2020-1Z061)。