Yi Fengming, Ge Liuqing, Zhao Jie, Lei Yuan, Zhou Feng, Chen Zhifen, Zhu Youqing, Xia Bing
Department of Gastroenterology, Zhongnan Hospital of Wuhan University School of Medicine, China.
Intern Med. 2012;51(6):523-30. doi: 10.2169/internalmedicine.51.6685. Epub 2012 Mar 15.
Total parenteral nutrition (TPN) as a traditional mode of treatment in severe acute pancreatitis was still used widely in clinical work. In addition, enteral nutrition treatment methods have developed; early enteral nutrition has already been highlighted for severe acute pancreatitis, but the therapeutic risks versus benefits need to be studied.
To compare total parenteral nutrition with total enteral nutrition (TEN) in patients with severe acute pancreatitis by performing a meta-analysis.
Electronic databases including PubMed, EMBASE, Science Citation Index, were searched to find relevant randomized controlled trials. Two reviewers independently identified relevant trials evaluating the effect of total parenteral nutrition and early enteral nutrion. Outcome measures were the mortality, hospital length of stay, infectious complications, duration of nutrition, organ failure and surgical intervention.
Eight randomized controlled trials (RCTs) including 381 patients were identified. Meta-analysis demonstrated that TEN was significantly superior to TPN when considering mortality [p=0.001, 95%CI 0.37(0.21-0.68)], infectious complications [p=0.004, 95%CI 0.46(0.27-0.78)], organ failure [p=0.02, 95%CI 0.44(0.22-0.88)] and surgical intervention [p=0.003, 95%CI 0.41(0.23-0.74)].While no difference between TEN and TPN when considering the hospital length of stay [p=0.22, 95%CI -14.10(-36.48-8.26)] and as for duration of nutrition [p=0.72, 95%CI -1.50(-9.56-6.56)] there was not enough data to compare the differences.
Total enteral nutritional support is associated with lower mortality, fewer infectious complications, decreased organ failure and surgical intervention rate compared to parenteral nutritional support.
全胃肠外营养（TPN）作为重症急性胰腺炎的传统治疗方式，在临床工作中仍被广泛应用。此外，肠内营养治疗方法也有所发展；早期肠内营养已被视为重症急性胰腺炎的重要治疗手段，但治疗的风险与益处仍需研究。
通过荟萃分析比较全胃肠外营养与全肠内营养（TEN）在重症急性胰腺炎患者中的效果。
检索包括PubMed、EMBASE、科学引文索引在内的电子数据库，以查找相关随机对照试验。两名评审员独立识别评估全胃肠外营养和早期肠内营养效果的相关试验。观察指标包括死亡率、住院时间、感染性并发症、营养持续时间、器官衰竭和手术干预情况。
共识别出8项随机对照试验（RCT），涉及381例患者。荟萃分析表明，在死亡率[p=0.001，95%可信区间0.37（0.21-0.68）]、感染性并发症[p=0.004，95%可信区间0.46（0.27-0.78）]、器官衰竭[p=0.02，95%可信区间0.44（0.22-0.88）]和手术干预[p=0.003，95%可信区间0.41（0.23-0.74）]方面，TEN显著优于TPN。而在住院时间[p=0.22，95%可信区间-14.10（-36.48-8.26）]和营养持续时间方面[p=0.72，95%可信区间-1.50（-9.56-6.56）]，TEN与TPN之间无差异，且缺乏足够数据比较差异。
与胃肠外营养支持相比，全肠内营养支持可降低死亡率、减少感染性并发症、降低器官衰竭和手术干预率。
