鱼油营养支持对重症患者临床疗效及安全性的系统评价

Fish Oil Supplementation in Critically ill Patients: A Systematic Review

目的评价鱼油营养支持对于重症患者的疗效及安全性。方法系统检索cochrane图书馆、Cochrane图书馆临床对照试验资料库、美国全科医学文献数据库(MEDLINE)、生物医学与药理学文献数据库(EMbase)、中文期刊全文数据库(CNKI)和万方等数据库,全面收集鱼油治疗重症患者的随机对照试验(RCT),对文献进行质量评价,并采用Revman5.0软件进行统计分析。结果检索到鱼油用于重症患者的临床疗效及安全性的高质量的随机对照试验共11篇。按Jadad量表评分,1篇4分,1篇5分,1篇6分,其他8篇均为7分,纳入的随机对照试验研究质量均较高。Meta分析结果显示,鱼油营养支持可以降低危重患者的ICU住院天数及机械通气时间,两组比较差异具有统计学意义(P<0.000 01),鱼油营养支持未降低危重患者病死率及住院获得性感染率,未报道鱼油营养支持相关的严重不良反应。结论鱼油营养支持治疗有助于改善危重患者临床疗效中的某些指标,且耐受良好。由于纳入的研究数量有限,该系统评价的结果需谨慎对待,尚需更多的设计合理、多中心、大样本的RCT以进一步证实。

OBJECTIVE To evaluate the effect and safety of fish oil supplementation in critically ill patients. METHODS Co- chrane library, Cochrane Register of Controlled Trials, MEDLINE, EMbase, CNKI and Wanfang Data were searched for eligible litera- tures. The methodological quality of the included studies was evaluated and the data was analyzed by RevmanS. 0 software. RESULTS Eleven high-quality randomized controlled trials were included. The quality of the eleven studies was evaluated according to Jadad scale, of which one scored four points, one scored five points, one scored six points, the others all scored seven points. The result of meta-anal- ysis indicated that fish oil supplementation could reduce the length of stay in ICU and the time of ventilation（P 〈0. 000 01 ）, but it had no effect on mortality or the incidence of nosocomial infections. CONCLUSION It is demonstrated that fish oil supplementation is ef- fective and safe for critically ill patients. High-quality large-scale multiple-centered RCTs are required to confirm this finding.