肠内营养和全胃肠外营养比较在重症急性胰腺炎中应用的系统评价

Enteral nutrition vs total parenteral nutrition in patients with severe acute pancreatitis: A systematic review of randomized controlled trials

目的:采用循证医学方法评价肠内营养(enteral nutrition,EN)和全胃肠外营养(total parenteral n u t r i t i o n,T P N)比较治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的有效性和安全性.方法:制定严格纳入和排除标准,计算机检索Cochrane图书馆临床对照试验数据库(2013年第2期)、MEDLINE或PubMed(1978-2013年)、Embase(1978-2013年)、OVID数据库(1978-2013年)、中国生物医学文献数据库(CBMDisc)(1978-2013年)、维普中文期刊数据库(1989-2013年)、中国期刊全文数据库(1979-2013年)、万方学位论文数据库(1978-2013年).并手工检索相关会议论文集及查阅检索到的所有文献的参考文献,全面收集全世界关于EN和TPN比较治疗SAP的随机对照试验或对照试验.按照国际Cochrane协作网推荐的方法进行系统评价.结果:共纳入16个试验包括791例患者.Meta分析结果显示:EN与TPN比较,能显著降低病死率(OR=0.26,95%CI:0.16-0.45,P<0.00001),减少感染并发症及器官功能衰竭发生(OR=0.19,95%CI:0.13-0.27,P<0.00001)(OR=0.25,95%CI:0.09-0.66,P=0.005),减少手术干预(OR=0.22,95%CI:0.07-0.64,P=0.006),并能缩短住院时间,减少住院费用(WMD=-12.37,95%CI:-17.22--7.52,P<0.00001)(WMD=-1.90,95%CI:-2.40--1.39,P<0.00001).结论:目前的证据表明:在无EN禁忌情况下,SAP患者应首选EN作为常规治疗.

AIM： To assess the safety and efficacy of enteral nutrition and total parenteral nutrition in pa- tients with severe acute pancreatitis. METHODS： We searched Cochrane Central Register of Controlled Trails （CENTRAL）, MED- LINE or PubMed, Embase, OVID database, Chi- nese Biological Medicine database （CBMDisc）, CNKI, Chinese VIP database and Wanfang da- tabase to retrieve relevant articles. The bibliog- raphies of the retrieved articles and conference proceedings were searched manually. System- atic review was conducted using the methodrecommended by The Cochrane Collaboration RESULTS： Sixteen trials involving 791 patients were included in the systematic review. Meta- analysis showed that compared with total paren- teral nutrition, enteral nutrition was associated with a significantly lower mortality （OR = 0.26, 95%CI： 0.16-0.45, P 〈 0.00001）, lower incidence of infectious complications and organ failure （OR = 0.19, 95%CI： 0.13-0.27, P 〈 0.00001; OR = 0.25, 95%CI： 0.09-0.66, P = 0.005）, fewer surgical interventions （P = 0.006）, shorter hospitalization and fewer hospital fees （WMD = -12.37, 95%CI： -17.22-7.52, P 〈 0.00001; WMD =-1.90, 95%CI： -2.40-1.39, P 〈 0.00001）. CONCLUSION： The current evidence shows that enteral nutrition is safe and effective and is the preferred nutrition feeding method in patients with severe acute pancreatitis.