鼻胃管肠内营养在重症急性胰腺炎治疗中的疗效与耐受性分析  

Tolerance and efficacy of nasogastric enteral nutrition for severe acute pancreatitis:a metaanalysis

作　　者：冯淑芬[1] 汤绍辉[1] 张小娟[1] 

机构地区：[1]广州暨南大学附属第一医院消化科,广州510630

出　　处：《解放军医学杂志》2013年第2期141-146,共6页Medical Journal of Chinese People's Liberation Army

摘　　要：目的评价鼻胃管肠内营养（NGEN）在重症急性胰腺炎（say）治疗中的疗效与耐受性。方法检索外文数据库（1966-2011年）PubMed、Web of Science and The Cochrane Central Register of Controlled Trials及中文数据库（1978-2011年）中国期刊全文数据库（CNKI）、中国科技期刊数据库（维普）、万方数字化期刊全文数据库中有关NGEN与鼻空肠管肠内营养（NJEN）比较治疗SAP疗效的随机对照试验，由两个评价员对文献进行评价，意见不统一时通过讨论解决或由第三者判断。采用RevMan4．2软件对纳入研究（Jadad评分≥3分）进行Meta分析。结果共有3项随机对照试验纳入本研究。共纳人研究对象159例（2例退出研究），其中NGEN组82例（1例退出），NJENnY77例（1例退出）。Meta分析结果显示：NGEN组SAP的病死率（RR=0．69，95％CIo．37-1．29，P=O．2s）、手术干预情况（RR=2．09，95％C10．55-7．92，P=0．28）、营养相关性腹泻（RR=l_43，95％CIo．59-3．4S，P=0．43）、置管脱出率（RR=0．42，95％C10．08-2．17，P=0．30）及营养相关性疼痛（RR=0．94，95％CIo．32．-2．70，P=0．90）与N1EN组相比差异无统计学意义，而感染并发症（Rg=0．64，95％CIO．42-0．99，P=O．04）明显低于NJEN组。结论在SAP的肠内营养支持治疗中，NGEN与NJEN具有相似的临床疗效和耐受性，但前者感染并发症较后者低，且操作相对简便，具有取代后者的可能性。Objective To evaluate the tolerance and efficacy of nasogastric enteral nutrition （NGEN） in the treatment of severe acute pancreatitis （SAP）. Methods PUBMED, Web of Science and The Cochrane Central Register of Controlled Trials from 1966 to 2011 （up to October） and Chinese Journals Full-text Database （CNKI）, Database for Chinese Technical Periodicals （VIP） and Wanfang Digital Journal Full-text Database from 1978 to 2011 （up to October） were retrieved to collect clinical randomized controlled trials of NGEN to compare with nasojejunal enteral nutrition （NJEN） in the treatment of SAP. Two reviewers independently screened the literature for eligibility and evaluated the quality with confirmation of cross-check. Different opinions would be decided by the third party. Statistical analysis was performed by meta-analysis using Review Manager 4.2. Results Three randomized controlled trails including 1S9 patients with SAP met the inclusion criteria, involving 82 patients in NGEN group and 77 in NJEN group. There was no significant difference between NGEN and NJEN group in the risk of mortality of SAP （RR=0.69, 9S%CI： 0.37-1.29, P=0.2S）, conversion to surgery （RR-2.09, 95% CI： 0.55-7.92, P=0.28）, diarrhea subsequent to enteral nutrition （RR=1.43, 9S% CI： 0.S9-3.45, P=0.43）, rate of tube displacement （RR=0.42, 9S%CI： 0.08-2.17, P=0.30） and pain related with enteral nutrition （RR=0.94, 95%CI： 0.32-2.70, P=0.90）. While compared with NJEN, the risk of infectious complications was lower than NGEN （RR=0.64, 9S%CI： 0.42-0.99, P=0.04）. Conclusion In enteral nutrition support of SAP, NGEN is comparable to NJEN in efficacy and tolerance, but the former has the lower rate of infectious complications and easier to operate, and there is a tendency of NEGN to replace the latter

关 键 词：胰腺炎 急性坏死性 肠道营养 随机对照试验 

分 类 号：R576.1[医药卫生—消化系统]