低氮低热量肠外营养对腹部手术病人疗效及预后影响的Meta分析

Impact of low nitrogen low calorie parenteral nutrition in abdominal operation patients:a meta analysis

目的:系统评价低氮低热量肠外营养对腹部手术病人的疗效及疾病预后的影响。方法:检索7个生物医学数据库(CBM、Medline、Cochrane Library、Web of Science、CNKI等)的文献资料。按照Cochrane系统评价员手册,进行纳入随机对照研究的方法学质量评定,应用Rev Man 5.2软件进行Meta分析。结果:共纳入7项符合标准的临床随机对照试验(RCT)相关文献(n=565)。Meta分析显示,低氮低热量试验组可较好地控制血糖水平,较对照组降低1.36 mmol/L,95%CI[-2.01,-0.72],P<0.000 1,差异有统计学意义;试验组血清清蛋白含量平均增加1.31g/L,95%CI[-3.11,5.74],P=0.56,无显著性差异;低氮低热量肠外营养可减少病人术后并发症的发生率(平均为35%),95%CI[0.19,0.63],P=0.000 5,差异有统计学意义;卫生经济学方面,试验组住院天数平均缩短2.41天,95%CI[-3.80,-1.02],P=0.000 7,差异有统计学意义,试验组病人营养药品费用较对照组降低,合并SMD=-2.53,95%CI[-7.18,2.11],P=0.28,差异无统计学意义。结论:腹部术后病人早期给予低氮低热量肠外营养支持,可较好地控制血糖水平、降低并发症的发生率,同时减少术后住院时间,降低病人的医疗费用,有利于病人术后康复。

Objective： To assess the application of low nitrogen and low calorie parenteral nutrition support to abdominal operation patients. Methods： The following electronic databases were retrieved via computer system： CBMdisk, MEDLINE, Cochrane Library, Web of Science, CNKI et al. According to the Cochraneg quality scale of reports of randomized clinical trials, Meta analysis was conducted with Rev Man 5.2 Results ： Seven relevant RCT studies （ n = 565 ） were included. Meta analysis showed that there was a significantly lower blood glucose in experimental group by 1.36 mmol/L（95% CI [ -2.01, -0.72],P 〈 0.000 1 ）. The plasma albumin changed by 1.31 g/L（95 % CI[ - 3.11,5.74 ] , P = 0.56） without statistically significant. The incidence of complication after operation in experimental group was significantly lower than control group by 35 % （95 % CI[- 0.19,0.63 ], P = 0. 000 5 ）. The mean hospital days were significantly reduced by 2.41 days （95% CI[- 3.80, - 1.02 ], P = 0. 000 7）. And there was a lower nutrition medicine cost in experimental group （SMD = -2.53,95% CI [-7. 18, 2.11], P = 0.28） without statistically significant. Conclusion ： It can be inferred that low nitrogen and low calorie parenteral nutrition support to abdominal operation patients can control blood glucose, reduce the complication risk and the hospital days.