肠外免疫营养在急性胰腺炎治疗中作用的随机对照试验荟萃分析  

Parenteral immunonutrition in patients with acute pancreatitis:A meta-analysis of randomized controlled trials

作　　者：胡俊[1] 黄强[1] 林先盛[1] 刘臣海[1] 杨骥[1] 李瑞阳[1] 汪超[1] 

机构地区：[1]安徽医科大学附属安徽省立医院普外科 肝胆胰安徽省重点实验室,安徽省合肥市230001

出　　处：《世界华人消化杂志》2014年第30期4647-4653,共7页World Chinese Journal of Digestology

摘　　要：目的:探讨肠外免疫营养制剂在急性胰腺炎(acute pancreatitis,AP)肠外营养(parenteral nutrition,PN)中的作用.方法:计算机检索在2014-05-31在PubMed、Medline、Embase、Science Direct、CBM、Springer link、VIP及CNKI数据库公开发表的关于肠外免疫营养在治疗AP中疗效的英文文献,由2位研究者严格按纳入、排除标准独立进行文献筛选(PRISMA标准)、资料提取和方法学质量评价,并采用RevMan 5.2.7软件进行Meta分析.结果:共纳入7篇文献,共包含AP患者264例,其中行肠外免疫营养制剂患者130例,行常规PN制剂患者134例.Meta分析结果显示:肠外免疫营养组与常规PN组对比,其感染发生率较低(RR=0.56,95%CI:0.39-0.82,P=0.002)、住院时间较短(RR=-5.63,95%CI:-9.69--1.57,P=0.007)、病死率也较低(RR=0.23,95%CI:0.10-0.52,P<0.001).结论:AP进行PN治疗时,使用肠外免疫营养制剂能显著减少相关并发症和改善预后,值得临床上推广.但仍需大样本、多中心、前瞻性随机对照研究来进一步验证肠外免疫营养制剂在AP治疗中的优点.AIM： To evaluate the effects of parenteral immunonutrition on clinical outcomes [infectious complications, length of hospital stay（LOS） and mortality] in patients with acute pancreatitis. METHODS： Pubmed, Medline, Embase, Science Direct, CBM, Springer link, VIP and CNKI were electronically searched before 31 st May 2014 to collect the articles on parenteral immunonutrition in acute pancreatitis. The quality of the included trials was assessed according to the inclusive and exclusive criteria, and the data were extracted and analyzed using RevMan5.2.7 software. RESULTS： A total of seven randomized controlled trials studies with 264 pancreatitis patients were included. The number of patients receiving parenteral immunonutrition was 130 and the number of patient receiving standard parenteral nutrition was 134. Meta-analysis showed that parenteral immunonutrition significantly reduced the risk of infectious complications（RR = 0.56, 95%CI： 0.39-0.82, P = 0.002） and mortality（RR = 0.23, 95%CI： 0.10-0.52, P 0.001）. LOS was also shorter in patients who received immunonutrition（RR =-5.63, 95%CI：-9.69--1.57, P = 0.007）. CONCLUSION： Immunonutrients like glutamine and omega-3 fatty acids added to parenteral formulas can improve prognoses in patients with acute pancreatitis. Our findings still need to be verified by large, multicenter prospective randomized controlled trials.

关 键 词：急性胰腺炎 肠外营养 谷氨酰胺 Ω-3多不饱和脂肪酸 

分 类 号：R657.51[医药卫生—外科学]