含鱼油脂肪乳肠外营养对危重症患者影响的Meta分析

Effect of parenteral nutrition containing fish oil fat emulsion in critically ill patients:a Meta-analysis

目的系统评价含鱼油脂肪乳的肠外营养对成年危重症患者的影响。方法计算机检索万方、CNKI、The Cochrane Library(Cochrane Central Register of Controlled Trials)、pubmed数据库。按照纳入标准对研究进行资料提取、利用改良Jadad评分进行方法学质量评价,采用RevMan5.1软件进行Meta分析。结果共纳入28个随机对照实验(randomized controlled trail,RCT),共计1 444例患者,其中含9个高质量研究。Meta分析结果显示,鱼油组急性生理与慢性健康Ⅱ(acute physiology and chronic heath evaluationⅡ,APACHEⅡ)评分[SMD=-0.55,95%CI(-0.76,-0.34),P<0.000 01,I2=44%]、ICU停留时间[SMD=-1.06,95%CI(-1.43,-0.70),P<0.000 01,I2=84%]、感染性并发症[OR=0.42,95%CI(0.28,0.65),P<0.000 1;I2=0%]与对照组差异均有统计学意义。但2组28d病死率[OR=0.59,95%CI(0.32,1.10),P=0.10,I2=0%]差异无统计学意义。结论鱼油脂肪乳肠外营养可部分改善成年危重症患者的临床疗效,但并未对患者近期预后产生影响。

Objective To evaluate the effect of parenteral nutrition containing fish oil fat emulsion on adult critically ill patients.Methods Studies were identified by Wanfang,CNKI,The Cochrane Library（Cochrane Central Register of Controlled Trials）,pubmed search for original articles.According to the inclusion criteria and Jadad,data of the included studies were extracted,and the methodological quality was evaluated.Then Meta-analysis was performed using RevMan5.1.Results A total of 28 RCTs involving 1444 patients including 9high quality trials were included. Meta-analysis showed that compared with controlled group, Acute Physiology and Chronic Health Evaluation（APACHE）Ⅱscore[SMD=-0.55,95%CI（-0.76,-0.34）,P〈0.000 01,I2=14%],Length of ICU stay[SMD=-1.06,95%CI（-1.43,-0.70）,P〈0.000 01,I2=84%]and infectious complications [OR=0.42,95%CI（0.28,0.65）,P〈0.000 1,I2=0%]had significant differences.But there were no significant difference in 28-d mortality[OR=0.59,95%CI（0.32,1.10）,P=0.10,I2=0%].Conclusion The parenteral nutrition containing fish oil fat emulsion can partly improve the conditions of criticallyill patients,but did not affect the recent prognosis.