Feng Ping, He Chenjian, Liao Guqing, Chen Yanming
aIntensive Care Unit of the Affiliated Nanhua Hospital, University of South China bDepartment of Dermatology, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, China.
Medicine (Baltimore). 2017 Nov;96(46):e8648. doi: 10.1097/MD.0000000000008648.
Whether early enteral nutrition (EEN) administration is more beneficial than delayed enteral nutrition (DEN) for patients with acute pancreatitis remains controversial.
This meta-analysis aimed to pool all relevant articles to evaluate the effects of EEN within 48 hours versus DEN beyond 48 hours on the clinical outcomes of patients with acute pancreatitis. We searched PubMed, Scopus, Embase, and Web of Science for all relevant studies and extracted the data concerning basic characteristics, complications, and mortality. We calculated the pooled risk ratio (RR), weighted mean difference, and the corresponding 95% confidential interval (95% CI) using STATA 12.0.
For complications, the pooled analysis showed that EEN was related to a reduced risk of multiple organ failure (RR = 0.67, 95% CI 0.46-0.99, P = .04), but not for necrotizing pancreatitis (RR = 0.95, 95% CI 0.81-1.12, P = .57). There was a tendency for decreased systemic inflammatory response syndrome in the EEN group, but the trend was not significant (RR = 0.85, 95% CI 0.71-1.02, P = .09). For mortality, no significant difference was found between the EEN and DEN groups (RR = 0.78, 95% CI 0.27-2.24, P = .64).
EEN within 48 hours is superior to DEN beyond 48 hours for patients with acute pancreatitis; however, more studies are required to verify this conclusion.
对于急性胰腺炎患者，早期肠内营养（EEN）给药是否比延迟肠内营养（DEN）更有益仍存在争议。
本荟萃分析旨在汇总所有相关文章，以评估48小时内的EEN与48小时后的DEN对急性胰腺炎患者临床结局的影响。我们在PubMed、Scopus、Embase和Web of Science中检索了所有相关研究，并提取了有关基本特征、并发症和死亡率的数据。我们使用STATA 12.0计算合并风险比（RR）、加权平均差及相应的95%置信区间（95%CI）。
对于并发症，汇总分析表明，EEN与多器官功能衰竭风险降低相关（RR = 0.67，95%CI 0.46 - 0.99，P = 0.04），但与坏死性胰腺炎无关（RR = 0.95，95%CI 0.81 - 1.12，P = 0.57）。EEN组全身炎症反应综合征有下降趋势，但不显著（RR = 0.85，95%CI 0.71 - 1.02，P = 0.09）。对于死亡率，EEN组和DEN组之间未发现显著差异（RR = 0.78，95%CI 0.27 - 2.24，P = 0.64）。
对于急性胰腺炎患者，48小时内的EEN优于48小时后的DEN；然而，需要更多研究来验证这一结论。
