肠内营养启动时机对重症急性胰腺炎预后影响的Meta分析

Timing of enteral nutrition on prognosis of patients with severe acute pancreatitis: A meta-analysis

目的系统评价早期肠内营养(EEN)和延迟肠内营养(DEN)对重症急性胰腺炎(SAP)患者预后的疗效及安全性。方法截至2014年5月,计算机检索Pub Med、Ovid、Cochrane Library、Embase、Wan Fang、CNKI,收集肠内营养治疗SAP的临床随机对照试验(RCT)。按照Cochrane系统评价方法对纳入文献进行资料提取和质量评价,采用Rev Man 5.2软件对纳入的文献进行Meta分析。结果最终共纳入6个RCT,合计723例患者。Meta分析结果显示,EEN组其SAP患者病死率[OR=0.29,95%CI(0.13,0.65),P=0.003]、多器官功能障碍综合征(MODS)发生率[OR=0.48,95%CI(0.27,0.86),P=0.010]、胰腺感染[OR=0.35,95%CI(0.16,0.77),P=0.009]、胰腺外周感染发生率[OR=0.60,95%CI(0.38,0.95),P=0.030]及呼吸衰竭发生[OR=0.35,95%CI(0.16,0.77),P=0.009]明显优于DEN组患者,但是两组患者间外科手术干预[OR=0.58,95%CI(0.25,1.39),P=0.220]及肺炎发生率[OR=0.86,95%CI(0.54,1.37),P=0.530]比较,差异均无统计学意义。结论与DEN组相比,EEN可以降低病死率,MODS、呼吸衰竭、胰腺及胰腺外周感染的发生率,对SAP患者进行早期营养支持治疗,48 h内启动肠内营养可明显改善临床结局。

Objective To evaluate the efficacy and safety of early enteral nutrition （EEN） and delayed euteral nutrition （DEN） on the prognosis of patients with severe acute pancreatitis （SAP）. Methods The randomized controlled trials （RCT） on enteral nutrition in patients with severe acute pancreatitis （SAP） were identified from PubMed, Ovid, Cochrane Library, Embase, Wanfan and CNKI up to May 2014. The RCTs were extracted and checked the data, and was assessed by the methodological quality by the criteria of the Cochrane Handbook. Meta-analyses were performed by using RevMan 5.2 software. Results Six RCT involving 723 patients were included. The results of meta-analyses showed that patients in the EEN group had significantly decreased mortality [OR = 0.29, 95%CI （0.13, 0.65）, P= 0.003], multiple organ dysfunction syndrome （MODS） incidence [OR =0.48, 95%CI （0.27, 0.86）, P=0.010], pancreatic infection [OR = 0.35, 95%CI （0.16, 0.77）, P= 0.009], the incidence of peripheral pancreas infection [OR = 0.60, 95%CI （0.38, 0.95）, P= 0.030], and respiratory failure incidence [OR = 0.35, 95%CI （0.16, 0.77）,P = 0.009] as compared with those in the DEN group. However, the incidences of surgical intervention [OR = 0.58, 95%CI （0.25, 1.39）, P=0.220] and pneumonia [OR =0.86, 95%CI （0.54, 1.37）, P= 0.530] showed no significant differences between the two groups. Conclusions EEN can reduce mortality, the incidences of MODS, respiratory failure, pancreas and peripheral pancreas infection. Early nutritional support for SAP patients, especially enteral nutritioninitiated within 48 hours, ean improve the clinical outcomes.