Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan Province 410078 China.
Department of Science and Education, Peace Hospital of Changzhi Medical College, Changzhi, Shanxi Province 046000, China.
Biosci Rep. 2018 Nov 15;38(6). doi: 10.1042/BSR20181515. Print 2018 Dec 21.
We conducted a comprehensive analysis to evaluate the treatment efficacy and safety of enteral nutrition (EN) and parenteral nutrition (PN) in severe acute pancreatitis (SAP) patients, and to provide a basis for their evidence based application in a clinical setting. We conducted a systematic online search of the PubMed, Web of Science, Wanfang, and China National Knowledge Infrastructure databases, from their inception to November 2017. Studies were subjected to further screening if they met the inclusion/exclusion criteria. Eleven studies were subjected to qualitative and quantitative synthesis; these included a total of 562 patients (281 for EN and 281 for PN). No significant heterogeneity across studies was found. The results indicated that EN can significantly decrease the mortality rate (relative risk [RR] = 0.43, 95% confidence interval [CI]: 0.23-0.78, =0.006), and lowers the risk of infection and complications (RR = 0.53, 95% CI: 0.39-0.71, =0.000) more so than does PN. The EN group had a similar risk of multiple organ failure (MOF) compared with the PN group (RR = 0.63, 95% CI: 0.39-1.02, =0.059). The use of EN was also found to significantly reduce mean hospitalization time (mean difference = -2.93, 95% CI: -4.52-1.34, =0.000). No publication bias was found. Our meta-analysis suggested that EN, but not PN, significantly reduced the risk of mortality, infection, and complications for patients with SAP. EN support also decreased the rate of MOF and surgical intervention. EN is recommended as an initial treatment option for patients with SAP.
我们进行了全面的分析，以评估肠内营养（EN）和肠外营养（PN）在重症急性胰腺炎（SAP）患者中的治疗效果和安全性，并为它们在临床应用中的循证依据提供基础。我们对 PubMed、Web of Science、万方和中国国家知识基础设施数据库进行了系统的在线检索，检索时间从建库至 2017 年 11 月。如果研究符合纳入/排除标准，我们将对其进行进一步筛选。11 项研究进行了定性和定量综合分析；这些研究共包括 562 名患者（EN 组 281 例，PN 组 281 例）。研究之间没有发现显著的异质性。结果表明，EN 能显著降低死亡率（相对风险 [RR] = 0.43，95%置信区间 [CI]：0.23-0.78，=0.006），降低感染和并发症的风险（RR = 0.53，95% CI：0.39-0.71，=0.000），优于 PN。EN 组与 PN 组发生多器官衰竭（MOF）的风险相似（RR = 0.63，95% CI：0.39-1.02，=0.059）。EN 的使用也显著缩短了平均住院时间（均数差 = -2.93，95% CI：-4.52-1.34，=0.000）。未发现发表偏倚。我们的荟萃分析表明，EN 而非 PN 可显著降低 SAP 患者的死亡率、感染和并发症风险。EN 支持还降低了 MOF 和手术干预的发生率。EN 被推荐作为 SAP 患者的初始治疗选择。
