急性胰腺炎患者肠外营养和肠内营养治疗的Meta分析

Meta-analysis of the effectiveness of parenteral nutrition and enteral nutrition in acute pancreatitis

目的探讨急性胰腺炎患者肠外和肠内营养治疗的疗效。方法采用Meta分析的方法,检索1966年1月至2011年3月国内外文献数据库,对国内外学者公开发表的有关急性胰腺炎营养治疗的研究文献进行综合定量分析,衡量指标为病死率、感染率、多器官功能衰竭发生率、手术干预率和住院时间。结果经筛选有13篇文献入选,与传统肠外营养相比,急性胰腺炎患者采用肠内营养的病死率降低了61%(95%CI=24%～63%),感染率降低了45%(95%CI=38%～79%),多器官功能衰竭率降低了69%(95%CI=20%～48%),手术干预降低了73%(95%CI=18%～42%),而住院时间差异无统计学意义(P=0.91)。结论与急性胰腺炎患者肠外营养相比,肠内营养可以降低病死率、感染发生率、多器官衰竭发生率和手术干预率,建议早期采用肠内营养。

Objective To analyze the effects of total parenteral nutrition（TPN） and enteral nutrition （EN） in patients with acute pancreatitis. Methods Electronic databases from January 1966 to March 2011 about randomized controlled trial of nutrition therapy in patients with acute pancreatitis were enrolled and Meta-analysis of these randomized controlled trial was used, the measurement index were morbidity, infection rate, multiple organ failure （MOF） rate, surgery intervention rate and length of stay. Results A total of 13 trials was included. Compared with conventional parenteral nutrition, morbidity of enteral nutrition in patients with acute pancreatitis reduced by 61% （95% CI = 24%- 63%, P= 0.0001）, and infection rate reduced by 45% （95%CI=38%-79%, P〈0.01）, and the multiple organ failure reduced by 69% （95% CI= 20% - 48%, P〈 0.01 ）, and the surgery intervention reduced by 73%（95% CI = 18% -42%, P〈 0.01 ）. However, there was no statistically significant about the length of stay between EN and PN. Conclusions In patients with acute panereatitis, enteral nutrition significantly reduced mortality, infections, multiple organ failure and surgery intervention compared to those who received TPN. This data suggests that EN should be considered the better way for patients with acute pancreatitis requiring nutritional support.