肠内营养治疗重度烧伤临床疗效及安全性的Meta分析

Meta-analysis of the Clinical Efficacy and Safety of Enteral Nutrition in the Treatment of Severe Burns

目的系统评价肠内营养治疗重度烧伤的临床疗效及安全性。方法计算机检索PubMed、Web of Science、Cochrane Library、中国期刊全文数据库(中国知网)、中国生物医学文献数据库、中国学术期刊数据库(万方)、中文科技期刊数据库(维普)等数据库建库至2022年11月公开发表的重度烧伤患者早期应用肠内营养治疗的随机对照试验文献,采用改良Jadad量表及漏斗图进行文献质量评价,并采用RevMan 5.4软件对文献进行数据合并及分析。结果共纳入符合标准的文献11篇,包含重度烧伤患者753例。Meta分析结果显示,肠内营养组重度烧伤患者创面愈合时间、恢复正氮平衡时间均明显短于肠外营养组(SMD=-1.09、-1.44,95%CI为-1.26~-0.92、-1.67~-1.21,P均<0.00001),第7天及第14天血清白蛋白水平均明显高于肠外营养组(MD=2.84、2.55,95%CI为1.77~3.92、1.43~3.67,P均<0.00001),并发症发生率低于肠外营养组(RR=0.43,95%CI为0.34~0.55,P<0.00001)。结论与肠外营养治疗相比,重度烧伤患者早期进行肠内营养治疗更有利于促进创面愈合,缩短恢复正氮平衡时间,提高血清白蛋白水平,减少并发症发生,更值得临床推广应用。

Objective To systematically evaluate the clinical efficacy and safety of enteral nutrition in the treat-ment of severe burns.Methods Computer-based literature search was conducted to retrieve randomized controlled trial studies on early enteral nutrition treatment for severe burns published by November 2022 from the establishment of the following databases as PubMed,Web of Science,Cochrane Library,China National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature Database,China Science Periodical Database(Wanfang),China Science and Technology Journal Database(VIP).The modified Jadad scale and funnel plots were used to evaluate the quality of the retrieved papers,and RevMan 5.4 software was applied to merge and analyze these documents.Results A total of 11 papers screened out from the retrieved literature were included in the study,with 753 severe burns patients involved.Meta-analysis showed that the wound healing time and time to positive nitrogen balance were significantly shorter in the enteral nutrition group compared to the parenteral nutrition group(SMD=-1.09 and-1.44,95%CI:-1.26--0.92,-1.67--1.21,both P<0.00001).Serum albumin levels respectively on day 7 and 14 were significantly higher in the enteral nutrition group(MD=2.84 and 2.55,95%CI:1.77-3.92,1.43-3.67,both P<0.00001),and the incidence of complications was lower in the enteral nutrition group(RR=0.43,95%CI:0.34-0.55,P<0.00001).Conclusion Compared with paren-teral nutrition,early enteral nutrition treatment for patients with severe burns can significantly promote their wound healing,shorten the recovery time to positive nitrogen balance,improve serum albumin levels,and reduce the incidence of complica-tions,deserving to be promoted in clinical practice.