Early Parenteral Nutrition Alone or Accompanying Enteral Nutrition in Critically Ill Patients: A Systematic Review and Meta-Analysis

危重症患者行早期肠外营养治疗临床疗效的meta分析

Xiao Wan ； Xue-Jin Gao ； Feng Tian ； Chao Wu ； Xin-Ying Wang

《Asia Pacific Journal of Clinical Nutrition》 24卷2期 (2015/06) Pp. 227-233

https://doi.org/10.6133/apjcn.2015.24.2.07

摘要

背景：尽管一些大样本临床研究已经探究了早期肠外营养（early parenteral nutrition，ePN）在危重症患者的作用，但对于其疗效并没有达成共识，而且在这一领域也未见相关的meta分析报道。本研究的目的就是探究早期肠外营养在危重症患者中的治疗作用。方法：选取含有早期肠外营养的临床治疗的文献，对其数据进行meta分析，并根据患者是否合并使用早期肠内营养（early enteral nutrition，eEN）再进行亚组分析。结果：本研究总计纳入5篇随机对照研究（randomized control trials，RCTs）。结果显示，早期肠外营养组患者与对照组患者死亡率无明显差异（相对危险度：1.05,95%置信区间：0.96,1.16）。此外，与对照组相比，早期肠外营养组患者机械通气时间缩短（p=0.007，相对危险度：-0.95，95%置信区间：-1.64,-0.27），但是总住院时间延长（p＜0.001，相对危险度：3.76，95%置信区间：2.25,5.28）。结论：本meta分析表明，入院24-48小时以内的早期肠外营养并不会影响危重症患者死亡率。因此，肠内营养禁忌或者仅可使用低剂量肠内营养的患者无需使用早期肠外营养进行补充。

關鍵字

早期 ； 肠外营养 ； 危重 ； 肠内营养 ； 死亡率

並列摘要

Background: Although several large-scale clinical trials shave examined the relationship between early parenteral nutrition (ePN) and critically ill patients, a consensus has not been reached. In addition, no meta-analysis in this area has yet been published. The objective of this meta-analysis was to examine the effect of ePN, alone or accompanying enteral nutrition, in critically ill patients. Methods: A meta-analysis was performed to evaluate risk ratios (RR) and mean differences with 95% confidence intervals (CIs) between the ePN and control groups. Subgroup analyses were conducted to evaluate combinations of early enteral nutrition (eEN). Results: Five randomized control trials (RCTs) were included. Compared with controls, ePN had no effect on mortality (RR: 1.05, 95% CI: 0.96, 1.16). Secondary outcomes were variable: compared with the control group, the ePN group required fewer days of ventilation (p=0.007, RR: -0.95, 95% CI: -1.64, -0.27), but a longer hospital stay (p＜0.001, RR: 3.76, 95% CI: 2.25, 5.28). Conclusion: Overall, this meta-analysis from RCTs indicates that provision of ePN within 24-48 hours has no benefit on the survival rate in critically ill patients. Thus, provision of ePN in patients is not needed in those who have contraindications to enteral nutrition or can tolerate a low volume of enteral nutrition.

並列關鍵字

early ； parenteral nutrition ； critically ill ； enteral nutrition ； mortality