低热量肠内营养对危重症患者临床结局影响的Meta分析

Meta analysis of the eff ect of low calorie enteral nutrition on clinical outcomes in critically ill patients

目的评价低热量肠内营养在危重患者中的应用效果,为今后的相关研究提供证据。方法计算机检索The Cochrane Library、Medline、Embase、万方、中国知网等数据库,搜集关于低热量肠内营养在危重患者中应用效果的随机对照试验(RCT),检索时间从建库到2021年5月,按照纳排标准进行筛选文献并提取相关数据,对纳入文献进行Cochrane评价系统后采用Re Man 5.4进行Meta分析。结果共纳入13篇文献(英文9篇,中文4篇),包含3148例患者。Meta分析结果显示,与正常热量肠内营养相比,低热量肠内营养对危重患者的ICU住院时间[MD=0.49,95%CI(-1.34,2.31),P=0.60]、28 d死亡率[OR=1.01,95%CI(0.84,1.21),P=0.93]、感染发生率[OR=0.93,95%CI(0.77,1.13),P=0.46]无影响;与正常热量肠内营养相比,低热量肠内营养可以降低胰岛素的使用量[MD=-5.27,95%CI(-10.26,-0.27),P=0.04]、腹泻的发生率[OR=0.60,95%CI(0.40,0.89),P=0.01]和胃潴留的发生率[OR=0.18,95%CI(0.08,0.40),P<0.0001]。结论低热量肠内营养可降低危重患者营养不耐受的发生率,但在感染发生率、死亡率和ICU住院时间上的影响与正常热量肠内营养相比差异P>0.05,无统计学意义。

Objective To evaluate the application ef fect of low-calorie enteral nutrition in critically ill patients,and to provide evidence for future studies.Methods The Cochrane Library,Medline,Embase,Wanfang,CNKI and other databases were searched to collect randomized controlled trials(RCT)on the effect of low-calorie enteral nutrition in critically ill patients from the establishment of the database to May 2021.According to the inclusion and exclusion criteria,the literature was screened and relevant data were extracted.The Cochrane evaluation system was used to perform Meta analysis by using ReMan5.4.Results A total of 13 articles(9 in English and 4 in Chinese)were included,including 3148 patients.Meta analysis results showed that compared with normal caloric enteral nutrition,the ef fects of low calorie enteral nutrition on ICU length of stay[MD=0.49,95%CI(-1.34,2.31),P=0.60],28-day mortality[OR=1.01,95%CI(0.84,1.21),P=0.93]and incidence of infection in critically ill patients[OR=0.93,P=0.93],95%CI(0.77,1.13),P=0.46]had no ef fect.Compared to normal caloric enteral nutrition,low caloric enteral nutrition could reduce the consumption of insulin[MD=-5.27,95%CI(-10.26,-0.27),P=0.04],the incidence of diarrhea[OR=0.60,95%CI(0.40,0.89),P=0.01]and the incidence of gastric retention[OR=0.18,P=0.04],95%CI(0.08,0.40,P<0.0001).Conclusion Low calorie enteral nutrition could reduce the incidence of nutritional intolerance in critically ill patients,but there were no signifi cant dif ference in the incidence of infection,mortality and length of ICU stay compared with normal caloric enteral nutrition(P>0.05).