摘要
[目的]系统评价早期低热卡肠内营养支持在危重症病人中的应用效果。[方法]计算机检索PubMed、EMbase、Web of Science、Cochrane Central Register of Controlled Trials(CEN-TRAL)、CINAHL、Physiotherapy Evidence Database(PEDro)、中国生物医学文献服务系统(CBM)、中国知网(CNKI)、万方数据库中关于危重症病人早期低热卡肠内营养支持的随机对照试验,检索时限为建库至2017年6月30日,经筛选文献,提取资料与评价质量后行Meta分析。[结果]共纳入9项随机对照试验,Meta分析结果显示,与足量热卡肠内营养支持相比,早期低热卡肠内营养支持能够降低营养支持不耐受的发生率[OR=0.39,95%CI(0.17,0.91),P=0.03],能减少肠内营养支持期间胰岛素治疗量[MD=-5.53,95%CI(-8.17,-2.89),P<0.000 1],但不能缩短重症监护室治疗时间[MD=0.15,95%CI(-0.69,0.98),P=0.73],不能降低住院期间死亡率[OR=0.93,95%CI(0.78,1.10),P=0.39]和感染发生率[OR=0.99,95%CI(0.84,1.17),P=0.90]。[结论]与足量热卡肠内营养支持相比,早期低热卡肠内营养支持能够降低危重症病人营养支持不耐受的发生率、减少胰岛素治疗量,但并不影响ICU治疗时间、病人死亡率、感染发生率。
Objective:To systematically evaluate the application effect of early hypocaloric enteral nutrition support in critically ill patients.Methods:To retrieve randomized controlled trials related to early hypocaloric enteral nutrition support in critically ill patients in PubMed,EMbase,Web of Science、Cochrane Central Register of Controlled Trials(CENTRAL),CINAHL,Physiotherapy Evidence Database(PEDro),CNKI,CBM and Wanfang Database by computer.The retrieval time was from database construction to June 30,2017.Meta analysis was conducted after literature selection,data extraction and quality evaluation.Results:A total of 9randomized controlled trials were selected.Meta analysis results showed that compared with normocaloric enteral nutrition support,early hypocaloric enteral nutrition support could reduce the incidence of nutritional support intolerance(OR=0.39,95%CI(0.17,0.91),P=0.03),and could reduce the amount of insulin therapy during enteral nutrition support[MD=5.53,95%CI(8.17,2.89),P<0.0001),but it could not shorten the intensive care unit treatment time[MD=0.15,95%CI(0.69,0.98),P=0.73],reduce the mortality[OR=0.93,95%CI(0.78,1.10),P=0.39]and the incidence of infection[OR=0.99,95%CI(0.84,1.17),P=0.90]during hospitalization.Conclusions:Compared with normocaloric enteral nutrition support,early hypocaloric enteral nutrition support could reduce the incidence of nutritional support intolerance for critically ill patients,reduce the amount of insulin,but had no effect on ICU treatment time,patient mortality and incidence of infection.
作者
王芳
姚志清
陈璐
傅巧美
WANG Fang;YAO Zhiqing;CHEN Lu;FU Qiaome(The Affiliated Hospital of Nanjing University Medical School,Jiangsu 210008 China)
出处
《护理研究》
北大核心
2019年第5期748-753,共6页
Chinese Nursing Research
基金
2017年度南京市医学科技发展项目
编号:YKK17069
2017年度南京大学医学院附属鼓楼医院护理科研课题
编号:ZSB883
关键词
低热卡
早期
肠内营养
危重症
营养支持
不耐受
胰岛素
系统评价
并发症
hypocalorie
early
enteral nutrition
critically ill
nutrition support
intolerance
insulin
system evaluation
complication
