危重患者肠内营养喂养不耐受危险因素的meta分析

Meta-analysis of risk factors for enteral nutrition feeding intolerance in critically ill patients

目的分析危重患者肠内营养(EN)期间喂养不耐受的危险因素,为保障患者顺利摄入EN提供依据。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、中国生物医学文献数据库、万方、维普等数据库关于EN喂养不耐受危险因素的文献,检索时间为2010年1月至2020年11月,两位研究者独立进行文献筛查、资料提取和质量评价,然后通过RevMan 5.3进行meta分析。结果纳入14篇文献包含11个危险因素,共有2458例患者参与研究,其中病例组978例,对照组1480例;各因素meta分析合并比值比(OR)后,急性生理与慢性健康评分(APACHEⅡ)≥20分、低格拉斯哥昏迷(GCS)评分、抗生素种类≥2种、体温≥38.5℃、高血糖、儿茶酚胺类药物、口服钾制剂、血清白蛋白、早期使用胃动力药等比较,差异有统计学意义(P<0.05)。结论根据患者的危险因素和保护因素采取预防有效措施,可以降低喂养不耐受的发生率。

Objective To analyze the risk factors of feeding intolerance during enteral nutrition(EN)in critically ill patients,and to provide a basis for ensuring the smooth intake of EN in patients.Methods The pieces of literature on the risk factors of enteral nutrition feeding intolerance published from January 2010 to November 2020 in databases such as PubMed,Embase,Web of Science,Cochrane Library,CNKI,China Biology Medicine disc,Wanfang,VIP were searched by computer.Two researchers independently carried out literature screening,data extraction and quality evaluation,and then conducted meta-analysis by RevMan 5.3.Results 14 articles were included containing 11 risk factors,and a total of 2458 patients were analyzed and divided into 978 cases in the case group and 1480 cases in the control group.After the odds ratio(OR)of each factor was combined by meta-analysis,it was found that there were statistically significant differences in acute physiology and chronic health evaluation(APACHEⅡ)≥20,low score of Glasgow Coma Scale(GCS),antibiotic types≥2,body temperature≥38.5℃,hyperglycemia,catecholamine drugs,oral potassium preparations,serum albumin,and early use of gastric motor drugs(P<0.05).Conclusion Taking preventive and effective measures according to the patient’s risk factors and protective factors can reduce the incidence of feeding into lerance.