重症急性胰腺炎病人肠内营养喂养不耐受危险因素的Meta分析

Meta-analysis of risk factors for enteral nutritional feeding intolerance in patients with severe acute pancreatitis

目的:系统评价重症急性胰腺炎病人肠内营养喂养不耐受的危险因素。方法:计算机检索中国知网(CNKI)、维普数据库(VIP)、中国生物医学文献数据库(CBM)、万方数据库(WanFang Database)、PubMed、EMbase、Web of Science有关重症急性胰腺炎病人肠内营养喂养不耐受危险因素的文献,检索时限为从建库至2021年11月30日,由2名研究者独立进行文献筛选、资料提取和质量评价,运用RevMan 5.4软件和Stata 15.0软件进行Meta分析。结果:共纳入11篇文献,包括2 270例病人,Meta分析结果显示,年龄>60岁(OR=1.88)、急性生理功能和慢性健康状况评价系统Ⅱ(APACHEⅡ)评分≥20分(OR=4.18)、低钾血症(OR=1.59)、肠内营养开始时间>72 h(OR=2.24)、未添加膳食纤维(OR=3.72)、腹内压>15 mmHg(1 mmHg=0.133 kPa,OR=2.91)、中心静脉压>10 cmH_(2)O(1 cmH_(2)O=0.098 kPa,OR=1.96)、机械通气(OR=1.41)是重症急性胰腺炎病人肠内营养喂养不耐受的危险因素,合并结果差异有统计学意义(P<0.05)。结论:现有证据表明,年龄>60岁、APACHEⅡ评分≥20分、低钾血症、肠内营养开始时间>72 h、未添加膳食纤维、腹内压>15 mmHg、中心静脉压>10 cmH_(2)O、机械通气是重症急性胰腺炎病人肠内营养喂养不耐受的危险因素。

Objective:To systematically evaluate the risk factors for enteral nutritional feeding intolerance in Chinese patients with severe acute pancreatitis.Methods:CNKI,VIP,WanFang Database,China Biomedical Literature Database,PubMed,EMbase,Web of Science were searched for literature on risk factors of enteral nutritional feeding intolerance in patients with severe acute pancreatitis,the time was from inception to November 30,2021.Two researchers independently conducted literature screening,data extraction and quality evaluation,and the Meta-analysis was performed using RevMan 5.4 software and Stata 15.0 software.Results:A total of 11 articles were included,involving a total of 15 related risk factors.The risk factors with statistical significance included age>60 years old(OR=1.88),acate physiology and Chronic Health Evaluation(APACHE)Ⅱ score≥20 points(OR=4.18),hypokalemia(OR=1.59),enteral nutrition starting time>72 h(OR=2.24),no dietary fiber added(OR=3.72),and intra-abdominal pressure>15 mmHg(1 mmHg=0.133 kPa,OR=2.91),central venous pressure>10 cmH_(2)O(1 cmH_(2)O=0.198 kPa,OR=1.96),mechanical ventilation(OR=1.41).Conclusion:The available evidence suggests that age>60 years old,APACHEⅡ score≥20 points,hypokalemia,enteral nutrition starting time>72 h,no dietary fiber added,intra abdominal pressure>15 mmHg,central venous pressure>10 cmH_(2)O,and mechanical ventilation are risk factors for enteral nutrition feeding intolerance in patients with severe acute pancreatitis.