Health Services Research Unit, University of Aberdeen, UK.
Crit Care Med. 2013 Jan;41(1):307-16. doi: 10.1097/CCM.0b013e3182657578.
To determine whether the supplementation of parenteral nutrition with ω-3 fatty acids confers treatment benefits to critically ill adult patients.
We performed computerized searches for relevant articles from 1996 to June 2011 on MEDLINE, EMBASE, and the Cochrane register of controlled trials and abstracts of scientific meetings from 2005 to 2011.
Randomized controlled trials of ω-3 fatty acid supplemented parenteral nutrition in critically ill adult patients admitted to the intensive therapy unit, given in addition to their routine care, compared with parenteral nutrition without ω-3 fatty acid supplementation.
Five fully published trials and three trials published in abstract form with 391 participants have been included. Overall trial quality was poor. Mortality data were pooled from eight studies with 391 participants. No differences were found with a risk ratio for death of 0.83 (95% confidence interval 0.57, 1.20; p = 0.32). Data for infectious complications were available from five studies with 337 participants. No differences were found, with a risk ratio for infection of 0.78 (95% confidence interval 0.43, 1.41; p = 0.41). Data for intensive therapy unit and hospital length of stay were available from six and three studies with 305 and 117 participants, respectively. With respect to intensive therapy unit length of stay, no differences were observed with a mean difference of 0.57 days in favor of the ω-3 fatty acid group (95% confidence interval -5.05, 3.90; p = 0.80). A significant reduction in hospital length of stay of 9.49 days (95% confidence interval -16.51, -2.47; p = 0.008) was observed for those receiving ω-3 fatty acid supplemented parenteral nutrition, but results were strongly influenced by one small study.
On the basis of this systematic review, it can be concluded that ω-3 fatty acid supplementation of parenteral nutrition does not improve mortality, infectious complications, and intensive therapy unit length of stay in comparison with standard parenteral nutrition. Although ω-3 fatty acids appear to reduce hospital length of stay, the poor methodology of the included studies and the absence of other outcome improvements mean they cannot be presently recommended.
确定ω-3 脂肪酸的肠外营养补充是否对危重症成年患者具有治疗益处。
我们在 MEDLINE、EMBASE 和 Cochrane 对照试验注册库中进行了计算机检索，检索了 2005 年至 2011 年科学会议的摘要，以寻找 1996 年至 2011 年 6 月的相关文章。
在重症监护病房接受治疗的危重症成年患者中，除了常规治疗外，给予ω-3 脂肪酸补充的肠外营养与不给予ω-3 脂肪酸补充的肠外营养进行比较的随机对照试验。
纳入了 5 项完全发表的试验和 3 项以摘要形式发表的试验，共 391 名参与者。整体试验质量较差。对 8 项研究（391 名参与者）的死亡率数据进行了汇总。死亡风险比无差异，为 0.83（95%置信区间 0.57,1.20；p=0.32）。有 5 项研究（337 名参与者）提供了感染并发症的数据。无差异，感染风险比为 0.78（95%置信区间 0.43,1.41；p=0.41）。有 6 项和 3 项研究分别提供了重症监护病房和医院住院时间的资料，涉及 305 名和 117 名参与者。关于重症监护病房住院时间，ω-3 脂肪酸组有 0.57 天的优势（95%置信区间-5.05，3.90；p=0.80），但差异无统计学意义。接受ω-3 脂肪酸补充的肠外营养者的住院时间显著缩短 9.49 天（95%置信区间-16.51，-2.47；p=0.008），但结果受到一项小型研究的强烈影响。
基于这项系统评价，我们可以得出结论，与标准肠外营养相比，ω-3 脂肪酸肠外营养补充并不能改善死亡率、感染并发症和重症监护病房住院时间。尽管ω-3 脂肪酸似乎可以缩短住院时间，但由于纳入研究的方法学较差，且没有其他结果改善，因此目前不能推荐使用。
