全身炎症反应综合征患者营养支持疗效的Meta分析

Meta analysis of efficacy of nutritional support of patients with systemic inflammatory response syndrome

目的评价不同临床营养治疗方案对全身炎症反应综合征(SIRS)的疗效及安全性。方法采用中、英文检索词,计算机检索国内、外数据库,筛选随机对照试验(RCT)研究,采用RevMan 4.2.7统计软件进行Meta分析。结果共纳入8个RCT研究。常规营养与谷氨酰胺联合常规营养、非硒治疗与硒治疗比较,SIRS患者病死率的差异无统计学意义。常规营养与富含鱼油脂肪乳联合常规营养进行比较,SIRS患者院内感染发生率差异有统计学意义(OR值0.33,95%CI为0.09～1.27);常规营养与谷氨酰胺联合常规营养进行比较,SIRS患者院内感染、多器官功能障碍综合征(MODS)发生率差异均有统计学意义(OR值分别为0.32、1.74,95%CI分别为0.12～0.85、0.58～5.27)。采用谷氨酰胺、低热卡进行干预,结果显示治疗组与对照组急性生理功能和慢性健康状况评分(APACHE)Ⅱ分数降低值差异有统计学意义(WMD分别为4.0、4.9,95%CI分别为2.36～5.64、1.76～8.04)。结论谷氨酰胺、低热卡摄入可部分降低SIRS患者的感染、MODS发生率以及APACHEⅡ分数。

Objective To evaluated efficacy and safety of different therapeutic methods of clinical nutrition on systemic inflammatory response syndrome（SIRS）.Methods Chinese and English search terms were used,computer retrieval of domestic and foreign database were conducted,and randomized controlled trials（RCT） were selected.Meta-analysis was performed by statistical software RevMan 4.2.7.Results A total of 8 RCT were included.Compared with conventional nutrition and combination with glutamine and conventional nutrition,non-selenium and selenium treatment,there were no statistically differences in mortality of patients with SIRS.Comparison of conventional nutrition and combination with intralipid rich in fish oil and conventional nutrition showed statistically differences in incidence rates of nosocomial infection of patients with SIRS（OR value was 0.33;95% CI was 0.09-1.27）.Difference of incidence rates of nosocomial infection and multiple organ dysfunction syndrome（MODS） of patients with SIRS were statistically significant when compared with conventional nutrition and combination with glutamine and conventional nutrition（OR values were 0.32,1.74,respectively;95%CI were 0.12-0.85,0.58-5.27,respectively）.With glutamine and low calorie intervention,the results showed that the difference of reducing value of acute physiology and chronic health evaluation（APACHE） Ⅱ scores between treatment and control group had statistically significance（WMD were 4.0,4.9,respectively,and 95% CI were 2.36～5.64,1.76～8.04,respectively）.Conclusion Glutamine,low calorie intake can partially reduce the incidence rates of infection,MODS and APACHE II scores of patients with SIRS.