腹内压监测与床旁超声监测对ICU病人早期肠内营养效果的Meta分析  

Effect of intra-abdominal pressure monitoring and bedside ultrasound monitoring on early enteral nutrition in ICU patients:a Meta-analysis

作　　者：胡菲菲 王芳 王永妮 黄诗倪 王智 明瑶 龙芳 HU Feifei;WANG Fang;WANG Yongni;HUANG Shini;WANG Zhi;MING Yao;LONG Fang(School of Nursing,Chengdu University of Traditional Chinese Medicine,Sichuan 610075 China)

机构地区：[1]成都中医药大学护理学院,四川610075 [2]广安市中医院

出　　处：《循证护理》2024年第18期3231-3240,共10页Chinese Evidence-Based Nursing

摘　　要：目的:系统评价腹内压监测与床旁超声监测胃残余量对重症监护室(ICU)病人早期肠内营养的应用效果。方法:计算机检索PubMed、EMbase、the Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网、万方数据库、维普数据库中关于ICU病人使用腹内压监测或床旁超声监测胃残余量指导下进行早期肠内营养的随机对照试验,检索时限为建库至2024年1月。由2名研究人员依据纳入、排除标准筛选文献,提取资料并评价文献质量,使用RevMan 5.4、Stata 17.0和ITC软件进行Meta分析。结果:最终纳入27篇文献。Meta分析结果显示,腹内压监测与床旁超声监测胃残余量均能降低病人呕吐、腹胀、腹泻发生率,改善病人的血清清蛋白水平,提高7 d肠内营养目标热量达标率。腹内压监测与床旁超声监测胃残余量对早期肠内营养病人应用效果(除血清清蛋白水平)间接比较的Meta分析结果显示,差异无统计学意义(P>0.05)。结论:现有证据表明,腹内压监测与床旁超声监测均可改善病人呕吐、腹胀、腹泻发生率,提高血清清蛋白水平和7 d肠内营养目标热量达标率,且两种方法的效果(除血清清蛋白水平)差异无统计学意义。临床实践可根据科室实际情况以及病人病情进行选择。Objective:To systematically evaluate the effects of intraabdominal pressure monitoring and bedside ultrasound monitoring of gastric residual volume on early enteral nutrition in ICU patients.Methods:Randomized controlled trials of early enteral nutrition in ICU patients guided by intra-abdominal pressure monitoring or bedside ultrasound monitoring of gastric residual volume were retrieved from PubMed,EMbase,the Cochrane Library,Web of Science,CBM,CNKI,WanFang Database,VIP.The search period was up to January 2024.Two researchers screened the literature according to inclusion and exclusion criteria,extracted data and evaluated the quality of the literature.RevMan 5.4,Stata 17.0 and ITC software were used for the Meta-analysis.Results:A total of 27 articles were included.The results of Meta-analysis showed that both intra-abdominal pressure monitoring and bedside ultrasound monitoring of gastric residual volume could reduce the incidence of vomiting,abdominal distension and diarrhea,improve the serum albumin level of patients,and increase the target calorie compliance rate of enteral nutrition for 7 days.The results of Meta-analysis(except serum albumin levels)of indirect comparison between intra-abdominal pressure monitoring and bedside ultrasound monitoring of gastric residual volume in early enteral nutrition patients showed no statistical significance(P>0.05).Conclusion:The existing evidence shows that both intra-abdominal pressure monitoring and bedside ultrasound monitoring can improve the incidence of vomiting,abdominal distension and diarrhea,and increase the serum albumin level and the target calorie compliance rate of enteral nutrition at 7 days,and the effect(except serum albumin levels)difference between the two methods is not statistically significant.Clinical practice can be selected according to the actual situation of the department and the patient′s condition.

关 键 词：腹内压监测 超声 危重症 早期肠内营养 META分析 循证护理 

分 类 号：R472.2[医药卫生—急诊医学]