针刺及电针对重症肠内营养患者喂养耐受性及营养状况影响的Meta分析  

The Effects of Acupuncture or Electro-acupuncture on the Feeding Tolerance and Nutritional Status of Patients with Enteral Nutrition in the Intensive Care Unit:A Meta-analysis

作　　者：张尚书 钱建锋[2] 董朝晖[2] 张月 钱茜 刘凤琪 廉洁 杜金磊 李菲 ZHANG Shangshu;QIAN Jianfeng;DONG Zhaohui;ZHANG Yue;QIAN Qian;LIU Fengqi;LIAN Jie;DU Jinlei;LI Fei(Huzhou University,Huzhou,313000:2.The First People's Hospital of Huzhou City,Zhejiang Province)

机构地区：[1]湖州师范学院医学院护理学院,浙江省313000 [2]湖州市第一人民医院

出　　处：《中医杂志》2021年第21期1869-1876,共8页Journal of Traditional Chinese Medicine

基　　金：湖州市科学技术局公益性应用研究项目(2017GYB08)。

摘　　要：目的系统评价针刺及电针对重症监护室肠内营养患者喂养耐受性及营养状况的影响。方法计算机检索万方数据库、中国知网、维普全文数据库、中国生物医学文献数据库、PubMed、Cochrane library、Web of science、Embase从建库至2020年8月1日收录的关于针刺或电针对ICU患者喂养耐受性及营养状况影响的随机对照研究(RCT),对符合纳入、排除标准的文献进行资料提取与质量评价,采用RevMan 5.4软件对喂养不耐受发生率及营养状况进行Meta分析,采用GRADE评价系统对结局指标进行证据质量评级。结果最终纳入15项RCT,合计1271例患者。Meta分析结果显示:与对照组常规治疗相比,针刺能够减少腹胀、腹泻、呕吐发生率,升高前白蛋白、血红蛋白水平(P<0.05),而对于便秘发生率和喂养量,差异无统计学意义(P>0.05);电针能够减少患者腹胀、腹泻、呕吐、反流发生率,提高患者营养达标比例,增加患者喂养量、前白蛋白与白蛋白水平,减少加用肠外营养比例及胃残余量(P<0.05),而对于便秘、误吸和血红蛋白水平差异无统计学意义(P>0.05)。根据GRADE标准,在针刺组与对照组比较方面,腹胀、腹泻、呕吐发生率为中质量证据,其余结局指标均为低质量证据;在电针组和对照组比较方面,便秘、误吸发生率、喂养量、前白蛋白水平、白蛋白水平为低质量证据,胃残余量和血红蛋白为极低质量证据,其余结局指标均为中质量证据。结论相比于常规治疗加肠内营养,联合针刺和电针治疗在减少ICU患者喂养并发症和改善营养状况方面有一定的优势,但是对于减少便秘发生率和增加喂养量,针刺优势不显著;对于减少便秘和误吸发生率、升高血红蛋白水平,电针优势不显著。Objective To evaluate the effects of acupuncture or electro-acupuncture on feeding tolerance and nutritional status of patients with enteral nutrition in the intensive care unit(ICU).Methods Electronic databases including Wanfang,CNKI,VIP,SinoMed,PubMed,Cochrane Library,Web of Science and Embase were searched for randomized controlled trials(RCTs)exploring the effect of acupuncture or electro-acupuncture on feeding tolerance and nutritional status in ICU patients from the inception dates to August 1st,2020.The papers meeting the inclusion and exclusion criteria were extracted for data and evaluated for quality assessment.RevMan 5.4 software was used to conduct meta-analyses on incidence of feeding intolerance and nutritional status.GRADE was used to assess the evidence quality of outcome.Results Fifteen RCTs were included involving 1271 patients.The meta-analyses results showed that compared to control group with routine treatment,acupuncture can significantly decrease the incidence of abdominal distension,diarrhea and vomiting,and increase the levels of prealbumin and hemoglobin(P<0.05),but there were no statistically significant differences between groups in constipation incidence and feeding amount(P>0.05).Electro-acupuncture can decrease the incidence of abdominal distension,diarrhea,vomiting and regurgitation,increase the proportion of patients with nutrition status up to the standard,elevate the feeding amount and the levels of prealbumin and albumin,and reduce the proportion of parenteral nutrition and residual gastric volume(P<0.05),but no statistically significant differences in constipation incidence,aspiration,and hemoglobin level were found between electro-acupuncture and routine treatment(P>0.05).According to the GRADE standard,the evidence on incidence of abdominal distention,diarrhea and vomiting compared between acupuncture and routine treatment was as sessed asmoderate certainty,while other outcomes were rated as low certainty.When compared between electro-acupuncture and routine treatment,the ev

关 键 词：针刺 电针 肠内营养 喂养耐受性 营养状况 META分析 

分 类 号：R246[医药卫生—针灸推拿学]