小肠内营养与胃内营养对呼吸机相关性肺炎影响的Meta分析

The effect of small intestinal feeding and intragastric feeding on ventilator-associated pneumonia: A Meta-analysis

目的:系统评价经小肠内营养和胃内营养对呼吸机相关性肺炎(VAP)的影响。方法:计算机检索数据库Cochrane Library、MEDLINE、EMBASE、ISI、CBM、VIP、CNKI和Wan Fang Data,搜集从建库至2015年2月关于胃内营养与小肠内营养对VAP随机对照试验(RCT),并对纳入研究的参考文献进行手工检索。由2名研究者独立进行文献质量评价和资料提取,采用Rev Man 5.3软件进行Meta分析,使用GRADEpro 3.6.1软件对结果证据进行评价分级。结果:纳入8个英文和9个中文RCT共1 241例病人。Meta分析结果显示,两组病人VAP的患病率[RR=0.55,95%CI(0.46~0.67),P<0.000 01]、机械通气时间[MD=-3.69,95%CI(-5.98^-1.41),P=0.002]和入住ICU天数[MD=-2.89,95%CI(-5.00^-0.78),P=0.007]差异均有显著性统计学意义,而ICU病死率[(RR=0.99,95%CI(0.74~1.33),P=0.95]则无统计学差异。漏斗图显示,纳入研究文献无发表偏倚,VAP患病率,ICU病死率结果证据质量为高证据等级,机械通气时间,入住ICU天数结果证据质量为中等级。结论:证据表明,小肠内营养与胃内营养相比,能降低VAP的患病率,缩短机械通气时间和入住ICU的天数,而对病死率则无影响。

Objective ： We performed a systematic review of randomized controlled trials evalua- ting the influence of the stomach or small intestine of the delivery of enteral nutrition ways on ventilator- associated pneumonia. Methods： Data sources were originated in Cochrane Library, Medline, EMBASE, Ovid CBM, VIP, CNKI, WANFANG data. The study included randomized controlled trials about enteral feeding of the patients with ventilator. Results： There were 17 randomized controlled trials. The incidence of ventilator associated pneumonia rate [ RR = 0.55, 95% CI （0.46 - 0. 67 ） , P 〈 0.000 01 ], mechanical ventilation time [ MD = -3.69,95% CI（ -5.98 - 1.41 ） ,P = 0.002 ] , and duration of ICU Stay [ MD = -2.89,95% CI （ - 5.00 - - 0.78 ）, P = 0. 007 ] were significantly different between two groups, but ICU mortality rate [ RR = 0.99,95% （0.74-1.33） ,P =0.95 ] were not significantly different. Conclusion： The current evidence shows that ventilator-associated pneumonia rate, ventilation day, and length of ICU stay were significantly different between two groups, and ICU mortality rate was notsignificantly different between two groups.