胃肠术后早期肠内营养对患者预后影响的Meta分析  

Prognosis of patients with early enteral nutrition after gastrointestinal operation： a meta-analysis

作　　者：舒晓亮[1] 康凯[1] 钟静霞[2] 姬舒荣[2] 王铭河[3] 张勇胜[4] 唐大寒[5] 

机构地区：[1]同济大学附属东方医院营养科,上海200120 [2]同济大学附属同济医院普通外科 [3]复旦大学附属肿瘤医院大肠外科 [4]广西医科大学第一附属医院临床营养科 [5]中南大学湘雅二医院临床营养科

出　　处：《中华胃肠外科杂志》2013年第11期1035-1040,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家“十二五”科技支撑计划课题（2012BA135803）

摘　　要：目的系统评价早期肠内营养对胃肠手术患者的预后影响。方法检索PubMed、Cochrane Library、中国生物医学文献数据库（CBM）、中国知网、万方和维普等数据库中有关术后早期肠内营养的临床随机对照研究，采用Jadad质量评价量表对纳入文献进行质量评价，提取营养指标、肠功能恢复指标、术后并发症及卫生经济学指标等结局资料，应用RevMan5．2软件进行Meta分析。结果11项临床随机对照研究共计1087例病例纳入分析，其中术后24h内予以肠内营养者541例（早期营养组），术后予以常规营养支持或单纯静脉输液者546例（对照组）。Meta分析结果显示．早期营养组患者术后血浆白蛋白和前白蛋白水平较对照组明显升高（WMD=2．87，95％CI：1．03。4．71：WMD=0．04，95％CI：0．02-0．05），术后肠通气恢复时间较对照组明显缩短（WMD=4．10，95％CI：-5．38—2．82），术后并发症发生率明显降低（RR=0．64，95％CI：0．44—0．93）。结论胃肠道手术后予以早期肠内营养，可以较好地改善患者的营养状况、促进肠道功能恢复并降低术后并发症发生率，是一种安全、有效的治疗方法。Objective To systematically assess the effect of early enteral nutrition support after gastrointestinal operation on prognosis. Methods The Cochrane Library, PubMed, CBM, CNKI, Wanfang, and VIP databases were retrieved via computer system for randomized controlled trails （RCTs） with early enteral nutrition support to patients undergoing gastrointestinal operation, Quality of studies was evaluated by the Cochrane Jadad rating scale. Nutrition indexes, bowel function indices, postoperative complications, health-economics indices were collected. Meta-analysis was conducted with RevMan 5.2. Results Eleven relevant RCTs studies with 1087 cases were enrolled, including 541 patients in the study group （early enteral nutrition） and 546 in the control group. Meta-analysis showed that patients in the study group had significantly higher levels of plasma albumin and prealbumin than those in the control group （WMD=2.87, 95%CI： 1.03-4.71 ; WMD=0.04, 95%CI：0.02-0.05）. The time of postoperative bowel ventilation in the study group was significantly shorter than that in the control group（WMD=g.10, 95%CI：-5.38- -2.82）. The postoperative complication rate in the study group was significantly lower as compared to the control group（RR=0.64, 95%CI：0.44-0.93）. Conclusion Early enteral nutrition support after gastrointestinal operation is safe and effective, which can improve the nutritional status, promote bowel function return, and reduce postoperative complication rate.

关 键 词：胃肠道手术 早期肠内营养 预后 META分析 

分 类 号：R656.6[医药卫生—外科学]