肠内营养和肠外营养支持对肝移植术后受者治疗效果的荟萃分析  

A systematic review of enteral nutrition versus parenteral nutrition on patient outcomes after liver transplantation

作　　者：朱涵菁 黄明珠[1] 潘宸 杨鹏飞 杨艳 Zhu Hanjing;Huang Mingzhu;Pan Chen;Yang Pengfei;Yang Yan(Department of Nursing,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;Department of Nursing,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;Shanghai Jiao Tong University School of Nursing,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属仁济医院护理部,上海200127 [2]上海市第一人民医院护理部,上海200080 [3]上海交通大学护理学院,上海200025

出　　处：《中华器官移植杂志》2022年第7期418-426,共9页Chinese Journal of Organ Transplantation

摘　　要：目的系统评价肝移植受者术后肠内营养(enteral nutrition,EN)与肠外营养(parenteral nutrition,PN)的治疗效果。方法检索数据库包括The Cochrane Library、Medline、EmBase、EBSCO、中国生物医学文献数据库(SinoMed)、中国期刊全文数据库(CBM)、中国科技期刊数据库CNKI(维普)、万方数据资源系统(万方),检索时间为从建库至2021年8月。纳入肝移植受者术后EN与PN相比较的随机对照试验(randomized control trial,RCT)。严格按照纳入及排除标准,由2位研究人员独立进行文献筛选、数据提取和文献方法学质量评价后,应用RevMan 5.3软件进行定量综合和统计分析。结果共纳入13篇RCT文献,文献质量等级均为B级,合计571例受者。Meta分析结果显示,与PN组相比,EN组受者血清白蛋白水平升高[WMD=2.5(1.33,3.68),WMD>0,P<0.0001],前白蛋白水平增加[WMD=59.78(32.22,87.35),WMD>0,P<0.0001],总胆红素水平降低[WMD=-27.81(-41.88,-13.74),WMD<0,P=0.0001],感染发生率显著降低[OR=0.25(0.16,0.39),OR<1,P<0.00001]。结论肝移植术后肠内营养相较肠外营养而言,能够提高受者营养水平,促进肝功能的恢复以及降低受者术后感染的发生率,具有一定的临床应用价值。Objective To systematically evaluate the therapeutic efficacy of enteral nutrition(EN)versus parenteral nutrition(PN)in patients after liver transplantation(LT).Methods The databases of Cochrane Library,MEDLINE,EmBase,EBSCO,Sinomed,CBM,CNKI and Wanfang Data were systematically searched up to August 2021 for collecting randomized controlled trials(RCT)of comparing EN and PN in patients after LT.In strict accordance with the inclusion and exclusion criteria,two independent researchers carried out literature screening,data extracting and literature methodological quality evaluations.Then RevMan5.3 software was utilized for quantitative synthesis and statistical processing.Results A total of 13 RCTs involving 571 grade B patients were included.Meta-analysis indicated that,as compared with PN,serum albumin of EN spiked[WMD=2.5(1.33,3.68),WMD>0,P<0.0001],prealbumin rose[WMD=59.78(32.22,87.35),WMD>0,P<0.0001],total bilirubin dropped[WMD=-27.81(-41.88,-13.74),WMD<0,P=0.0001]and infection incidence was significantly lower[OR=0.25(0.16,0.39),OR<1,P<0.00001].Conclusions After LT,as compared with PN,EN can boost the nutritional level,promote the recovery of liver function and lower the incidence of postoperative infections.It offers some clinical values.

关 键 词：肝移植 早期肠内营养 肠外营养 Meta分析 

分 类 号：R657.3[医药卫生—外科学]