[1]李 晗,田李均,徐俊贤,等.早期肠内营养治疗对脓毒症及脓毒性休克治疗效果的Meta分析[J].肠外与肠内营养杂志,2022,(01):35-40,45.[doi:DOI : 10.16151/j.1007-810x.2022.01.007]
　LI Han,TIAN Li-jun,XU Jun-xian,et al.A Meta-analysis of the effect for early enteral nutrition support in sepsis and septic shock[J].PARENTERAL & ENTERAL NUTRITION,2022,(01):35-40,45.[doi:DOI : 10.16151/j.1007-810x.2022.01.007]
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早期肠内营养治疗对脓毒症及脓毒性休克治疗效果的Meta分析
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2022年01期
页码:
35-40,45
栏目:
论著
出版日期:
2022-01-10

文章信息/Info

Title:
A Meta-analysis of the effect for early enteral nutrition support in sepsis and septic shock
作者:
李 晗; 田李均; 徐俊贤; 张晴晴; 韩旭东
南通大学附属南通第三医院重症医学科，江苏南通 226000
Author(s):
LI Han;  TIAN Li-jun;  XU Jun-xian;  ZHANG Qing-qing;  HAN Xu-dong
Department of Critical Care Medicine, Nantong Third People's Hospital, Nantong University, Nantong 226000, Jiangsu, China
关键词:
肠内营养 ; 脓毒症 ; 脓毒性休克 ; Meta分析
Keywords:
Enteral nutrition;  Sepsis;  Septic shock;  Meta-analysis
分类号:
R459.3，R459.7
DOI:
DOI : 10.16151/j.1007-810x.2022.01.007
文献标志码:
A
摘要:
目的：针对早期肠内营养(EEN)对脓毒症及脓毒性休克病人的临床治疗效果进行系统评价。 方法：通过计算机检索 PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data、VIP数据库收集 EEN治疗成人脓毒症或脓毒性休克病人的随机对照试验（RCT）研究，检索时限均从建库至 2021年 7月。由两位研究员背对背独立进行文献筛选、质量评价以及资料的提取，采用 RevMan 5.3 软件进行 Meta 分析。 结果：最终纳入 12 篇RCT，共包括 644例病人。Meta分析结果显示，与入院 48 h后延迟给予肠内营养或入院后给予肠外营养相比，入院 48 h以内给予 EEN对病人的 28 d死亡率（RR = 0.98，95%CI：0.62 ~ 1.54, P = 0.92）没有显著影响，而 EEN组病人的 ICU住院时间（MD = -4.08，95%CI：-4.67 ~ -3.49, P < 0.00001）和机械通气时间（MD= -2.09, 95%CI ：-2.78 ~-1.40 ，P < 0.00001）明显缩短，多器官功能障碍综合征（MODS）发生率（RR = 0.42，95%CI：0.24 ~ 0.73，P =0.002）明显降低，并且经治疗后，EEN组病人的序贯器官衰竭（SOFA）评分（MD = -1.63，95%CI：-2.59 ~ -0.67，P =0.0009）、降钙素原（PCT）（SMD = -1.57, 95%CI：-2.86 ~ -0.28, P = 0.02）及 C 反应蛋白（CRP）水平（SMD = -1.60,95%CI：-2.23 ~ -0.96，P < 0.00001）均明显降低；两组病人肾脏连续性替代治疗（CRRT）的发生率（RR = 0.90，95%CI：0.33 ~ 2.47，P = 0.84）没有统计学差异。 结论：当前证据显示，入院 48 h内给予 EEN对脓毒症及脓毒性休克病人的 28 d死亡率及 CRRT发生率没有影响，但是能降低病人的 MODS发生率，缩短 ICU住院时间和机械通气时间，降低 SOFA评分和炎症指标 PCT、CRP的水平。由于受到纳入研究数量和质量的限制，上述结论仍需开展更多高质量研究予以验证。
Abstract:
Objective: To systematically review the clinical efficacy of early enteral nutrition on patients with sepsis and septic shock. Methods: PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCT) on early enteral nutrition support in adult patients with sepsis or septic shock from inception to July 2021. Two reviewers selected literature, assessed risk of bias and collected data independently, the RevMan 5.3 software was used to perform meta-analysis. Results: A total of 12 articles were included, including 644 patients. The results of meta-analysis showed that: Compared with patients who were given enteral nutrition 48 hours after admission or given parenteral nutrition after admission, there was no statistical difference in 28-day mortality (RR = 0.98, 95%CI: 0.62 ~ 1.54, P = 0.92), but the lengths of ICU stay (MD = -4.08,95%CI: -4.67 ~ -3.49, P < 0.00001] and duration of mechanical ventilation [MD = -2.09, 95%CI (-2.78, -1.40), P <0.00001] in patients receiving early enteral nutrition within 48 hours after admission were significantly shortened, and the incidence of multiple organ dysfunction syndrome (MODS) (RR = 0.42, 95% CI: 0.24 ~ 0.73, P = 0.002) was significantly reduced, after treatment, the sequential organ failure assessment (SOFA) of patients (MD = -1.63, 95%CI: -2.59 ~ -0.67, P = 0.0009), level of procalcitonin (PCT) (SMD = -1.57, 95%CI: -2.86 ~ -0.28, P = 0.02) and C-reactive protein (CRP) (SMD = -1.60, 95% CI: -2.23 ~ -0.96, P < 0.00001) were obviously decreased in the group of early enteral nutrition; there was no statistical difference in the incidence of continuous renal replacement therapy (CRRT) (RR = 0.90, 95%CI：0.33 ~ 2.47, P = 0.84) between the two groups. Conclusions: Current evidence shows that early enteral nutrition within 48 hours after admission has no effect on 28-day mortality and CRRT incidence, but can reduce the incidence of MODS, shorten the lengths of ICU stay and duration of mechanical ventilation, and reduce the SOFA score and the levels of inflammation indicators in patients with sepsis and septic shock. Due to the limited number and quality of included studies, the above conclusions still need to be verified by more high-quality studies.

参考文献/References:


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备注/Memo

备注/Memo:
基金项目 ：江苏省南通市卫健委市级重点学科支持项目（wx2017002）；南通市科技计划项目（JC2020054，MSZ21030）；南通市卫健委科研 课题（MA2020017，MB2020036） 作者简介 ：李 晗，医师，医学硕士，从事重症医学专业。E-mail：lh961274125@163.com 通讯作者 ：韩旭东，E-mail：hanxudong9610@163.com
更新日期/Last Update: 1900-01-01