入院24小时内肠内营养治疗重症急性胰腺炎疗效的Meta分析

Efficacy of Enteral Nutrition within 24 Hours of Admission in Severe Acute Pancreatitis:a Meta-analysis

背景肠内营养是临床治疗重症急性胰腺炎(SAP)的重要手段之一,但其最佳启动时机尚存在争议。目的通过Meta分析方法评价入院24 h内肠内营养治疗SAP的疗效。方法计算机检索PubMed、EMBase、the Cochrane Library、Web of Science、中国知网、维普网、万方数据知识服务平台、中国生物医学文献服务系统,筛选关于入院24 h内肠内营养治疗SAP疗效的随机对照试验(RCT),检索时限均为建库至2021年7月。在常规治疗基础上,试验组患者入院24 h内进行肠内营养,对照组患者入院24 h后进行肠内营养或经口饮食,或入院后直接进行肠外营养。采用RevMan 5.4软件进行Meta分析。结果最终纳入13项RCT,包含1193例患者。Meta分析结果显示,试验组患者病死率〔RR=0.61,95%CI(0.39,0.95),P=0.03〕、多器官功能障碍综合征(MODS)发生率〔RR=0.56,95%CI(0.36,0.86),P=0.009〕、胰腺感染发生率〔RR=0.55,95%CI(0.33,0.91),P=0.02〕、治疗后急性生理学及慢性健康状况评价系统Ⅱ(APACHEⅡ)评分〔MD=-2.18,95%CI(-2.55,-1.80),P<0.00001〕低于对照组。亚组分析结果显示,对照组患者干预措施为入院后直接进行肠外营养时,试验组患者病死率〔RR=0.28,95%CI(0.11,0.73),P=0.009〕、MODS发生率〔RR=0.40,95%CI(0.20,0.79),P=0.009〕、胰腺感染发生率〔RR=0.50,95%CI(0.25,0.98),P=0.04〕低于对照组。结论当前研究证据表明入院24 h内肠内营养治疗SAP疗效较好,入院24 h内启动肠内营养对SAP的治疗是有益的。

Background Enteral nutrition(EN)is one important clinical treatment for severe acute pancreatitis(SAP),but the optimal timing of initiation remains controversial.Objective To evaluate the efficacy of EN within 24 hours of admission in the treatment of SAP by applying a Meta-analysis.Methods Databases of PubMed,EMBase,the Cochrane Library,Web of Science,CNKI,VIP,Wanfang Data and SinoMed were searched to identify randomized controlled trials(RCTs)about efficacies of usual care and EN within 24 hours of admission(experimental group)versus usual care in combination with EN or oral eating after 24 hours of admission or parenteral nutrition immediately after admission(control group)in SAP patients included from inception to July 2021.Meta-analysis was performed using RevMan 5.4 software.Results A total of 13 RCTs involving 1193 patients were included.Meta-analysis results revealed that,compared to usual care with control interventions,usual care with EN within 24 hours of admission had better effects on reducing the mortality〔RR=0.61,95%CI(0.39,0.95),P=0.03〕,incidence of multiple organ dysfunction syndrome(MODS)〔RR=0.56,95%CI(0.36,0.86),P=0.009〕and incidence of pancreatic infections〔RR=0.55,95%CI(0.33,0.91),P=0.02〕,and post-treatment APACHEⅡscore〔MD=-2.18,95%CI(-2.55,-1.80),P<0.00001〕.Further subgroup analysis indicated that,usual care with EN within 24 hours of admission was superior to usual care with parenteral nutrition immediately after admission in decreasing the mortality〔RR=0.28,95%CI(0.11,0.73),P=0.009〕,incidence of MODS〔RR=0.40,95%CI(0.20,0.79),P=0.009〕and pancreatic infections〔RR=0.50,95%CI(0.25,0.98),P=0.04〕.Conclusion Available evidence showed that,EN within 24 hours of admission had better efficacy for SAP,and initiating EN within 24 hours of admission may be beneficial to the treatment of SAP.