基于容量的肠内营养输注方案对ICU患者营养摄入影响的Meta分析

Meta-analysis of the effects of volume based feeding on nutrition intake of ICU patients

目的 系统评价基于容量和基于速率的肠内营养输注方案对ICU患者营养达标率的影响。方法 计算机检索Cochrane Library、Pub Med、Web of Science、中国知网、万方数据库、中国生物医学文献数据库和维普网,筛选有关基于容量和基于速率的肠内营养输注方案对重症患者营养摄入影响的随机对照试验和类试验研究,检索时限均从建库至2022年7月。由2名研究员独立筛选文献、提取资料并评价纳入研究的质量后,采用Rev Man 5.3软件进行Meta分析。结果 共纳入5项随机对照试验研究、4项类实验研究,包括718例患者。Meta分析显示,与基于速率的输注方式相比,基于容量的肠内营养输注方案能提高重症患者能量摄入的达标率[MD=16.58,95%CI(11.15,20.01),P<0.001]和蛋白摄入达标率,但两组在腹泻的发生率[OR=1.07,95%CI (0.72,1.58),P=0.75]、呕吐/反流的发生率[OR=0.77,95%CI(0.48,1.26),P=0.30]、ICU住院时长[MD=-0.11,95%CI(-0.15,0.94),P=0.84]等方面的差异均无统计学意义。结论与基于速率的肠内营养输注方案相比,基于容量的肠内营养输注方案在显著提升ICU患者营养摄入的同时,并不增加肠内喂养并发症的发生率,能有效保证患者的营养供给。

Objective To systematically evaluate the effects of volume based and rate based feeding on the nutrition intake of intensive care patients. Methods Cochrane Library,PubMed,Web of Science,CNKI,Wanfang Database,China Biomedical Database and VIP were searched for randomized controlled trials and quasi-experimental studies related to the effects of volume-based and rate-based feeding on compliance rate of nutrition in critically ill patients from the database’s inception to August 2022. After literature screening,data extraction and the risk of bias were evaluated independently by two researchers,meta-analysis was performed using RevMan 5.3 software. Results A total of 5 randomized controlled trials and 4 quasi-experimental studies were included,including 718 patients.Meta-analysis showed that compared with rate-based feeding,volume-based feeding scheme can improve the compliance rate of energy intake[MD=16.58,95%CI(11.15,20.01),P<0.001] and protein intake compliance rate in intensive care patients,but the differences in the incidence of diarrhea [OR=1.07,95%CI(0.72,1.58),P=0.75],the incidence of vomiting/reflux[OR=0.77,95%CI(0.48,1.26),P=0.30],ICU hospitalization length[MD=-0.11,95%CI(-0.15,0.94),P =0.84] and other aspects were not statistically significant between the two groups. Conclusion Compared with the traditional enteral nutrition scheme,volume based feeding could sig nif icantly improve the nutritional intake of critical patients,but did not increase the incidence of complications of enteral feeding,and could effectively ensure the nutritional supply of patients.