Moore F A, Feliciano D V, Andrassy R J, McArdle A H, Booth F V, Morgenstein-Wagner T B, Kellum J M, Welling R E, Moore E E
Department of Surgery, Denver General Hospital, Colorado 80204.
Ann Surg. 1992 Aug;216(2):172-83. doi: 10.1097/00000658-199208000-00008.
This two-part meta-analysis combined data from eight prospective randomized trials designed to compare the nutritional efficacy of early enteral (TEN) and parenteral (TPN) nutrition in high-risk surgical patients. The combined data gave sufficient patient numbers (TEN, n = 118; TPN, n = 112) to adequately address whether route of substrate delivery affected septic complication incidence. Phase I (dropouts excluded) meta-analysis confirmed data homogeneity across study sites, that TEN and TPN groups were comparable, and that significantly fewer TEN patients experienced septic complications (TEN, 18%; TPN, 35%; p = 0.01). Phase II meta-analysis, an intent-to-treat analysis (dropouts included), confirmed that fewer TEN patients developed septic complications. Further breakdown by patient type showed that all trauma and blunt trauma subgroups had the most significant reduction in septic complications when fed enterally. In conclusion, this meta-analysis attests to the feasibility of early postoperative TEN in high-risk surgical patients and that these patients have reduced septic morbidity rates compared with those administered TPN.
这项两部分的荟萃分析合并了八项前瞻性随机试验的数据，这些试验旨在比较早期肠内营养（TEN）和肠外营养（TPN）在高危手术患者中的营养效果。合并后的数据提供了足够的患者数量（TEN组，n = 118；TPN组，n = 112），以充分探讨底物输送途径是否会影响脓毒症并发症的发生率。第一阶段（排除失访者）的荟萃分析证实了各研究地点的数据同质性，TEN组和TPN组具有可比性，且TEN组发生脓毒症并发症的患者明显较少（TEN组为18%；TPN组为35%；p = 0.01）。第二阶段的荟萃分析是一项意向性分析（包括失访者），证实接受TEN治疗的患者发生脓毒症并发症的人数较少。按患者类型进一步细分显示，所有创伤和钝性创伤亚组在接受肠内喂养时，脓毒症并发症的减少最为显著。总之，这项荟萃分析证明了高危手术患者术后早期TEN的可行性，并且与接受TPN的患者相比，这些患者的脓毒症发病率降低。
