Pradelli Lorenzo, Mayer Konstantin, Klek Stanislaw, Omar Alsaleh Abdul Jabbar, Clark Richard A C, Rosenthal Martin D, Heller Axel R, Muscaritoli Maurizio
AdRes-Health Economics and Outcome Research, Turin, Italy.
Department of Internal Medicine, University Hospital of Giessen and Marburg, Giessen, Germany.
JPEN J Parenter Enteral Nutr. 2020 Jan;44(1):44-57. doi: 10.1002/jpen.1672. Epub 2019 Jun 27.
This systematic review and meta-analysis investigated ω-3 fatty-acid enriched parenteral nutrition (PN) vs standard (non-ω-3 fatty-acid enriched) PN in adult hospitalized patients (PROSPERO 2018 CRD42018110179). We included 49 randomized controlled trials (RCTs) with intervention and control groups given ω-3 fatty acids and standard lipid emulsions, respectively, as part of PN covering ≥70% energy provision. The relative risk (RR) of infection (primary outcome; 24 RCTs) was 40% lower with ω-3 fatty-acid enriched PN than standard PN (RR 0.60, 95% confidence interval [CI] 0.49-0.72; P < 0.00001). Patients given ω-3 fatty-acid enriched PN had reduced mean length of intensive care unit (ICU) stay (10 RCTs; 1.95 days, 95% CI 0.42-3.49; P = 0.01) and reduced length of hospital stay (26 RCTs; 2.14 days, 95% CI 1.36-2.93; P < 0.00001). Risk of sepsis (9 RCTs) was reduced by 56% in those given ω-3 fatty-acid enriched PN (RR 0.44, 95% CI 0.28-0.70; P = 0.0004). Mortality rate (co-primary outcome; 20 RCTs) showed a nonsignificant 16% reduction (RR 0.84, 95% CI 0.65-1.07; P = 0.15) for the ω-3 fatty-acid enriched group. In summary, ω-3 fatty-acid enriched PN is beneficial, reducing risk of infection and sepsis by 40% and 56%, respectively, and length of both ICU and hospital stay by about 2 days. Provision of ω-3-enriched lipid emulsions should be preferred over standard lipid emulsions in patients with an indication for PN.
本系统评价和荟萃分析调查了ω-3脂肪酸强化肠外营养（PN）与标准（非ω-3脂肪酸强化）PN在成年住院患者中的应用情况（国际前瞻性系统评价注册库编号：CRD42018110179）。我们纳入了49项随机对照试验（RCT），干预组和对照组分别给予ω-3脂肪酸和标准脂质乳剂，作为PN的一部分，提供≥70%的能量。感染的相对风险（主要结局；24项RCT）方面，ω-3脂肪酸强化PN组比标准PN组降低了40%（相对风险0.60，95%置信区间[CI]0.49 - 0.72；P < 0.00001）。接受ω-3脂肪酸强化PN的患者，其重症监护病房（ICU）平均住院时间缩短（10项RCT；1.95天，95%CI 0.42 - 3.49；P = 0.01），住院时间缩短（26项RCT；2.14天，95%CI 1.36 - 2.93；P < 0.00001）。脓毒症风险（9项RCT）在接受ω-3脂肪酸强化PN的患者中降低了56%（相对风险0.44，95%CI 0.28 - 0.70；P = 0.0004）。死亡率（共同主要结局；20项RCT）方面，ω-3脂肪酸强化组有16%的降低，但差异无统计学意义（相对风险0.84，95%CI 0.65 - 1.07；P = 0.15）。总之，ω-3脂肪酸强化PN有益，分别将感染和脓毒症风险降低40%和56%，并使ICU和住院时间均缩短约2天。对于有PN指征的患者，应优先提供ω-3强化脂质乳剂而非标准脂质乳剂。
