肠内营养对机械通气患者预后的荟萃分析

Meta analysis of the effects of enteral nutrition on mechanical ventilation adult patients

目的：评价肠内营养对机械通气患者的疗效。方法利用计算机检索已公开发表的有关肠内营养方式对机械通气患者疗效的中英文文献。按照纳入标准、排出标准纳入合格文献并进行质量评价。采用 Rev Man 5.1统计软件进行 meta 分析.结果共纳入15项随机对照研究,共962患者,其中有489例行肠内营养,473例行胃内营养.荟萃分析研究结果显示：机械通气患者留置肠管组较留置胃管组相比,呼吸机相关肺炎发生率、机械通气时间的差异有统计学意义（P 〈0.05）,合并相对危险度（RR）或均数差（MD）的95%可信区间（CI ）依次为0.44（0.34~0.57）,-3.65（-4.18^-3.12）。而住院时间、住 ICU 时间、病死率的差异无统计学意义（P 〉0.05）。结论机械通气患者留置肠管行肠内营养较留置胃管胃内营养患者发生呼吸机相关肺炎的概率低,机械通气的时间短；但患者住 ICU 时间、住院时间、病死率差异无统计学意义。

Objective To study the effect of jejunal tube feeding comparing with gastric tube feeding to prevent complication and prognosis onn mechanical ventilation adult patients.Methods English and Chinese literature about the enteral nutrition on mechanical ventilation adult were electrically searched.Meta-analysis was performed by Rev Man 5.3 software after the data of qualified studies were included in consistence with the criteria of inclusion and exclusion.Results Fifteen studies were including 962 cases （jejunal group 489,gastric group 473） met the inclusion criteria.Results of meta-analysis showed that there were significant difference between the jejunal group and the gastric group （P 〈0.05）.The relative risks（RRs）/Mean difference（MD）and 95% confidence intervals（CI ）of the risk of VAP（Ventilator-associated pneumonia） and the mechanical ventilation days were 0.44（0.34 ~ 0.57）,-3.65（-4.18 ~ -3.12）.However,there were no significant difference in the ICU days,the hospital days and the motality between the two groups（P 〉0.05）.Conclusions Mechanical ventilation patients fed by jejunal tube has a lower risk of ventilator-associated pneumonia （VAP） and shorter mechanical ventilation days than patients fed by gastric tube.But the ICU days,hospital days or motality show no difference between two groups.