低氮低热量肠外营养临床应用价值的系统评价

Clinical Values of Low-nitrogen Low-calorie Parenteral Nutrition:A Systematic Review

目的通过系统评价目前国内外所有可以查询到的有关低氮低热量肠外营养的随机对照试验(RCT),从而得出其临床应用的价值。方法检索Cochrane Library、MEDLINE、EMBASE、Tompson SCI、CNKI、VIP等数据库,采用循证医学中心提供的RevMan 5.1.2软件包完成整个研究的数据整合、Meta分析,采用GRADE 3.5.1软件包对主要测量指标进行证据等级的评估。结果纳入11篇文献,其中低风险文献共计2篇;术后第2、3、4、6、7、8天试验组和对照组患者的血糖水平比较差异有统计学意义,其中术后第2天的比较结果为〔SMD=-0.73,95%CI(-1.28,-0.18),I2=78%,P=0.009〕;试验组切口感染率为1.62%(3/185)、对照组为6.70%(12/179),差异有统计学意义〔RR=0.29,95%CI(0.10,0.88),I2=0,P=0.03〕;试验组和对照组静脉炎、全身炎症反应、总感染发生率及营养液配制时间差异均有统计学意义(P<0.05);试验组和对照组患者肠外营养药品费用、非营养相关费用差异均有统计学意义(P<0.05);试验组与对照组的术后第1天血糖水平、泌尿系感染发生率、肺部感染发生率、总营养相关费用、肠外营养器械费用、住院时间、血红蛋白、血浆清蛋白、转铁蛋白、血清前蛋白比较,差异均无统计学意义(P>0.05)。结论低氮低热量肠外营养对于术后高血糖的改善作用从第2天开始明显增强,可以降低术后感染的发生率,并且可以减少患者的部分住院费用,但是对于术后血红蛋白、血浆清蛋白、转铁蛋白、血清前蛋白,术后住院时间并未明显改善。本研究纳入的文献中高质量RCT较少,多中心、大样本的RCT纳入后是否会逆转本研究的结果则需进一步深入研究。

Objective To explore the clinical value of low-nitrogen low-calorie parenteral nutrition（PN） by systematically evaluating randomized controlled trials（RCTs）.Methods We searched databases including Cochrane Library,MEDLINE,EMBASE,Tompson SCI,CNKI,and VIP to retrieve relevant Chinese and English literatures.Data were processed and analyzed using RevMan 5.1.2 software.The level of evidence was assessed using GRADE3.5.1 software.Results Totally 11 literatures were included in the study,including two low-risk literatures.the blood glucose showed significant difference between the PN group and the control group 2,3,4,6,7,and 8 days after surgery,among which the SMD was-0.73（95%CI（-1.28-0.18） on the 2nd day after surgery I^2=78%,P=0.009）.The incision infection rate was 3/185 in PN group and 12/179 in control group（RR=0.29,95%CI（0.10,0.88）,I^2=0,P=0.03）.The incidences of phlebitis,systemic inflammatory response,the total incidence of infection,and nutrition preparation time were statistically significant（P0.05） between these two groups.The PN costs and non-nutrition-related costs of these two groups were significantly different（P0.05）.Blood sugar,urinary tract,lung infection,total nutrition-related fees,PN equipment costs,hospital stay,hemoglobin,serum albumin,transferrin,and prealbumin showed no significant difference between the two groups one day after surgery（P0.05）.Conclusion Low-nitrogen low-calorie PN can remarkably improve high blood sugar（especially from the second day after the surgery） reduce the incidence of postoperative infection,and decrease hospital costs;however,it has no notable effects on plasma hemoglobin,albumin,transferrin,prealbumin,and postoperative hospital stay.Since few high-quality RCTs were included in this review,whether the inclusion of more multi-center large-scale RCTs may alter the conclusion of this study requires further study.