营养治疗对重症急性胰腺炎预后的影响

Nutritional therapy on the prognosis of severe acute pancreatitis

目的系统评价肠内营养、肠外营养对重症急性胰腺炎预后的影响。方法采用co．chrane系统评价方法，由两名统计人员用计算机检索Cochrane图书馆、PubMed数据库、同时检索中国知网、中国生物医学文献数据库。收集国内外符合纳入标准的临床随机对照试验，按照纳入与排除标准选择文献，应用Revman5．0软件进行Meta分析。结果共纳入9个随机对照试验，包括381例研究对象。Meta分析显示，对于重症急性胰腺炎患者给予肠内营养治疗的效果较肠外营养而言，感染率明显降低（RR=0．37，95％CI[0．18，0．77]，P〈0．01）；胰腺感染率明显降低（RR=0．44，95％CI[0．24，0．81]，P〈0．01）；多器官功能障碍（MODS）率明显降低（RR=0．33，95％CI[0．19，0．56]，P〈0．0001），病死率下降（RR=0．45，95％CI[0．26，0．80]，P〈0．01），外科干预率明显降低（RR=0．51，95％CI[0．36，0．71]，P〈0．01）。对结果进行分层分析，入院48h内实施营养治疗的肠内营养组的感染率明显降低（RR=0．42，95％CI[0．21，0．81]，P=0．01）、MODS发病率明显降低（RR=0．39，95％C1[0．20，0．78]，P=0．008）和病死率明显降低（RR=0．28，95％ctco．11，0．73]），而48h后实施营养治疗的肠内营养组和肠外营养组的感染率和病死率差异无统计学意义。结论对于重症急性胰腺炎患者，早期（48h内）给予肠内营养治疗的疗效优于肠外营养。

Objective To study the effect of enteral nutrition（EN） and total parenteral nutrition（TPN） on patients with severe acute pancreatitis by a Meta analysis. Methods Randomized controlled trials of EN in patients with severe acute pancreatitis were searched in Cochrane library, Pubmed database, CNKI database, CBM database. Data were searched by two statisticians. RevMan 5.0 was applied for statistical analysis. Results Nine randomized controlled trials were enrolled into this analysis. Meta-analysis indicated that the use of enteral nutrition decreased the incidence of infectious complications （RR was 0.37,95% Cl [ 0.18, 0. 77 ] ）, pancreas infectious complications （ RR was 0.44,95 % CI [ 0.24,0.81 ], P 〈0. 01 ）, MODS （ RR was 0.33,95%CI[0. 19,0.56] ）, mortaily（RR was 0.45,95% CI [0.26,0.80] ）, surgical interventions （RR was 0.51,95% CI[0. 36,0.71 ] ）. When starting within 48 h of admission, EN, in comparison with TPN, resulted in a statistically significant reduction in the risk of MODS, mortally and infectious complications. Conclusion For patients with severe acute pancreatitis, early EN therapy is better than TPN.