不同胃残留量阈值设置对ICU行肠内营养患者影响的系统评价

Effects of gastric residual volume set at different thresholds on intensive care patients receiving en- teral nutrition： a systematic review

目的系统评价不同胃残留量（GRV）阈值设置对ICU行肠内营养（EN）患者的影响，为国内临床开展EN护理提供循证依据。方法计算机检索Cochranelibrary、PubMed、OvidMedline、Webof Science、中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方数据库、维普数据库（VIP）中有关不同GRV阈值设置对ICU行EN患者影响的临床对照试验，经筛选文献，提取资料与评价质量后采用RevMan5．3软件进行Meta分析或仅进行描述性分析。结果最终纳入4篇随机对照试验，1篇临床对照试验，共658例研究对象。Meta分析结果显示：GRV阈值≥250ml组肺炎[比值比（OR）=1．19，95％可信区间（CI）=0．77～1．82，P=0．43]、误吸（OR=1．59，95％CI=0．42—6．03，P=0．50）、呕吐（OR=1．35，95％CI=0．48～3．80，P=0．57）、反流（OR=1．29，95％CI=0．58—2．88，P=0．53）、腹泻（OR=1．36，95％CI=0．87～2．13，P=0．17）等发生率与GRV阈值〈250ml组比较，差异均无统计学意义（均P〉0．05）。营养摄入量与其他结局指标由于纳入研究的数量不足或评价指标存在差异的影响未能做Meta分析，采用描述性分析。结论ICU患者行EN期间GRV阈值≥250ml与〈250ml相比，对EN并发症发生率无影响，但在EN摄入量方面，GRV阈值≥250ml表现出明显优势。

Objective To compare the effects of gastric residual volume （GRV） set at different thresh- olds on intensive care patients receiving enteral nutrition （EN）, so as to inform clinical practice. Methods Controlled clinical trials involving different GRV thresholds in ICU patients undergoing EN were retrieved from multiple electronic databases （including Cochrane Library, PubMed, Ovid Medline, Web of Science, CBM, CNKI, Wanfang Data, and VIP）. Quality of the retrieved studies was evaluated for data extraction, and meta-a- nalysis was performed. Results Four randomized controlled trims and one clinically controlled trial were in- cluded in the study, with a total of 658 subjects. Results of the meta-analysis suggested no statistically signifi- cant difference between the group with GRV threshold ≥250 ml and the one with GRV threshold〈250 ml in the rates of pneumonia （OR=1. 19, 95% CI=0.77-1.82, P=0.43）, aspiration （OR= 1.59, 95% CI=0.42- 6. 03, P = 0. 50）, vomiting （ OR = 1.35, 95% CI = 0. 48-3.80, P = 0. 57）, reflux （ OR =1. 29, 95% CI = 0. 58-2. 88, P=0. 53） , and diarrhea （OR= 1.36, 95% CI=1. 87-2. 13, P=0. 17）. Nutrient intake and sev- eral other outcome measures were unable to be included in the meta-analysis for either the scarcity of studies or inconsistency in the measures adopted, and descriptive analysis was therefore employed instead. ConclusionThere was no significant difference between the two groups in terms of complications, but the group with GRV threshold ≥ 250 ml had higher intake of EN.