肠内营养支持预防压疮效果的meta分析  

Meta-analysis of enteral nutritional support for pressure ulcer prevention

作　　者：蒋琪霞[1] 郭艳侠[2] 杜世正[2] 王建东[3] 张玉红[2] 

机构地区：[1]南京军区南京总医院门诊部,南京医学硕士210002 [2]南京中医药大学,南京210043 [3]南京军区南京总医院病理科,南京210002

出　　处：《医学研究生学报》2015年第6期625-631,共7页Journal of Medical Postgraduates

基　　金：南京军区科技创新课题(14MS103);南京军区南京总医院科研基金(2010M012)

摘　　要：目的营养作为压疮发生发展中的一个要素引起专业人员的关注,但营养支持对于压疮预防所发挥的作用尚缺乏循证依据。文中采用meta分析的方法探讨肠内营养支持在预防压疮中的作用,旨在为指导存在压疮危险患者合理补充营养提供依据。方法使用"压疮预防"、"肠内营养支持"的中英文关键词,检索Cochrane图书馆、JBI数据库、MEDLINE、Web of Science、EMbase、CBMdisc、CNKI和万方数据库中相关的随机对照试验(randomized controlled trial,RCT),同时筛检纳入文献的参考文献。由3名研究者按纳入和排除标准独立筛选并对文献质量进行严格评价和资料提取,对符合质量标准的研究文献采用Rev Man5.0软件进行meta分析,采用Stata12.0软件进行偏倚检测和敏感度分析判断异质性来源。结果初筛相关文献484篇,最终共纳入6篇RCT文献进行meta分析(干预组728例、对照组825例),营养支持方式均为经口摄入,干预持续7d^26周。结果显示干预组压疮发生率较对照组降低16%(P=0.006),能量和蛋白质摄入高于对照组,住院时间缩短16 d,血清清蛋白差异无统计学意义(P>0.05)。结论肠内营养支持可明显降低有压疮危险患者的压疮发生率,循证证据等级为Ia级。Objective Nutrition becomes a focus to professionals as an important factor during the development of pressure ulcers. However,there is no evidence for the effectiveness of eternal nutrition support for pressure ulcer prevention. This research aimed to evaluate the effectiveness of eternal nutrition support for pressure ulcer prevention and provide evidence for patients with the risk of pressure ulcer. Methods Key words such as ＂ pressure ulcer prevention＂, ＂ eternal nutritional support＂ were used to search information in the Cochrane Library,JBI Database of Systematic Reviews,MEDLINE,Web of Science,EMbase,CBMdisc,CNKI and Wanfang Database to collect randomized controlled trials（ RCTs）. The quality of RCTs was critically appraised and data were extracted by 3 reviewers independently. Meta-analyses were conducted for the eligible RCTs using Rev Man5. 0 software,and Stata12. 0 software was applied to detect bias or sensitivity analysis to determine the source of heterogeneity if necessary. Results 7 RCTs were included,among which 1 RCT was excluded by sensitivity analysis. 6 RCTs（ n = 1553） were finally included for meta analysis（ n = 728 in trail group,n = 825 in control group）,and all the patients were given oral nutrition support for 7days to 26 weeks. The results showed that the ulcer incidence in the intervention group reduced by 16% in comparison to the control group（ P = 0. 006）. The protein and energy intake in intervention group were higher than those in control group,and the length of stay in hospital was shortened by 16 days.No significant difference was found in the albumin values. Conclusion The enteric nutrition support can reduce the incidence of pressure ulcer obviously with the highest level of evidence,IA.

关 键 词：肠内营养 营养补充剂 压疮 预防 META分析 

分 类 号：R459.3[医药卫生—治疗学]