肠内营养与肠外营养治疗重症急性胰腺炎疗效的Meta分析  

A Meta-analysis of efficacy of enteral nutrition and parenteral nutrition in patients with severe acute pancreatitis

作　　者：魏星[1] 李文星[2] 申素纲[2] 赵清丽[2] 李卓[3] 

机构地区：[1]山西医科大学,太原030001 [2]山西医科大学第二医院普外科,太原030001 [3]山西医科大学第二医院手术室,太原030001

出　　处：《中华临床医师杂志（电子版）》2016年第5期669-675,共7页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的营养支持是治疗重症急性胰腺炎(SAP)十分重要的措施之一。目前营养支持治疗的两种方式分别是肠内营养(EN)和肠外营养(PN)。本文对EN支持与PN支持分别治疗SAP的效果进行系统的评价,提供更多循证医学依据。方法根据中英文检索词通过计算机检索数据库Pub Med、万方数据知识服务平台、中国知网(CNKI),检索的时间段至2015年1月。关于EN支持治疗和PN支持治疗SAP的文献均纳入,而后对所得研究的参考文献进一步检出相关文献。对所出文献一一阅读,通过阅读其摘要或全文,根据制定的纳入/排除标准进一步筛选,对筛选出的文献中至少含有其中一种主要分析指标进行数据提取和质量评价后行统计学分析。结果共有9篇文献、450例患者符合。Meta分析结果显示:与PN组相比,EN组SAP患者病死率降低[RR=0.43、95%CI(0.23,0.78)、P=0.006],差异有统计学意义;外科手术干预率下降[RR=0.52、95%CI(0.36,0.74)、P=0.000 3],差异有统计学意义;感染及并发症的发生率降低[RR=0.56、95%CI(0.42,0.77)、P=0.000 2],差异有统计学意义;而在多器官衰竭发生率方面[RR=0.61、95%CI(0.25,1.47)、P=0.27],差异无统计学意义;在平均住院时间方面,EN组与PN组之间差异无统计学意义[WMD=0.73、95%CI(-9.23,10.69)、P=0.89]。结论早期EN支持治疗SAP患者在多器官衰竭发生率、平均住院时间方面与PN支持治疗比较差异无统计学意义,但其可降低病死率、感染与并发症的发生率及外科手术干预率,患者的预后比PN支持治疗效果好。因此,SAP患者的首选营养支持方式为早期EN支持治疗。Objective Nutritional support in patients with SAP is very important. The nutritional support treatment are respectively enteral nutrition （EN） and parenteral nutrition （PN）. Using Meta analysis to evaluate the treatment efficacy and safety of enteral nutrition and parenteral nutrition in severe acute pancreatitis （SAP）, and provide a basis for evidence-based medicine in clinical. Methods According to the English key words searched computer retrieval PubMed database, Wanfang Data knowledge service platform, China National Knowledge Infrastructure （CNKI）, the retrieval time was to 2015 January. The literature on EN support and PN support for the treatment of SAP were included, and then the reference literature for the study was further detected. By reading the literature, through reading the summary or the full text, according to the inclusion/exclusion criteria for further screening, the screening of the literature in at least one of the main analysis indicators for data extraction and quality evaluation of statistical analysis were performed. Results According to the selection criteria, nine articles were included in the study, a total of 450 patients were selected, the EN group 220 examples, the PN group 230 examples. The Meta statistical showed as follows： compared with PN group, in EN group of patients with SAP, fatality rate reduced, RR=0.43, 95% CI （0.23, 0.78）, P=0.006, the difference was statistically significant; Pancreatic infection and complication rate reduced, RR=0.56, 95% CI （0.42, 0.77）, P=0.000 2, the difference was statistically significant; surgical intervention rate reduced, RR=0.52, 95% CI （0.36, 0.74）, P=0.000 3, the difference was statistically significant; in respect of incidence of multiple organ failure, RR=0.61, 95% CI （0.25, 0.25）, P=0.27, there was no statistically significant difference. And in terms of average hospitalization time, there was no statistical difference between EN and PN group, WMD=0.73, 95% CI （-9.23, 10.69）, P=0.89. Conclusion The

关 键 词：肠内营养 肠外营养 重症急性胰腺炎 

分 类 号：R576[医药卫生—消化系统]