Department of Medicine, Taipei Veterans General Hospital, Taipei, Republic of China (Taiwan).
Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei, Republic of China (Taiwan).
PLoS One. 2019 Jul 10;14(7):e0219151. doi: 10.1371/journal.pone.0219151. eCollection 2019.
Infection in acute pancreatitis (AP) is associated with nutritional therapies including naso-gastric (NG), naso-jejunal (NJ), and total parenteral nutrition (TPN). To examine infections among NG, NJ, TPN, and no nutritional support (NNS) in treating patients with AP.
The investigators completed comprehensive search in the Cochrane library, EMBASE, PubMed, Web of Science, and ClinicalTrials.gov without restriction on language and publication date before January 21, 2019. They also searched the reference lists of relevant studies for randomized controlled trials (RCTs) comparing NG, NJ, TPN, and NNS among patients with AP. Quantitative synthesis was conducted in a contrast-based network meta-analysis. To clarify effects, a network meta-analysis was conducted to calculate the surface under the cumulative ranking curve (SUCRA). Beside of overall infections, the event rates of infected pancreatic necrosis, bacteremia, line infection, pneumonia, urinary tract infection, and other types of infections were measured.
The network meta-analysis of 16 RCTs showed that NJ had significantly lower overall infection rates compared with TPN (risk ratio: 0.59; 95% confidence interval: 0.38, 0.90); and NG had a larger effect size and higher rank probability compared with NJ, TPN, and NNS (mean rank = 1.7; SUCRA = 75.8). TPN was the least preferred (mean rank = 3.2; SUCRA = 26.6).
NG and NJ may be preferred therapies for treating patients with AP. Clinicians may consider NG as a first-line treatment for patients with AP (including severe AP) and even in patients receiving prophylactic antibiotics. In addition, we found that NNS should be avoided when treating patients with severe AP.
急性胰腺炎（AP）感染与包括鼻胃（NG）、鼻空肠（NJ）和全肠外营养（TPN）在内的营养治疗有关。本研究旨在比较 NG、NJ、TPN 和无营养支持（NNS）在治疗 AP 患者中的感染情况。
研究者在 Cochrane 图书馆、EMBASE、PubMed、Web of Science 和 ClinicalTrials.gov 中进行了全面检索，检索时间截至 2019 年 1 月 21 日，且未对语言和出版日期进行限制。他们还检索了相关研究的参考文献列表，以纳入比较 AP 患者中 NG、NJ、TPN 和 NNS 的随机对照试验（RCT）。在基于对照的网络荟萃分析中进行了定量综合分析。为了阐明效果，进行了网络荟萃分析以计算累积排序曲线下面积（SUCRA）。除了总体感染率外，还测量了感染性胰腺坏死、菌血症、导管感染、肺炎、尿路感染和其他类型感染的发生率。
纳入 16 项 RCT 的网络荟萃分析显示，与 TPN 相比，NJ 组的总体感染率显著降低（风险比：0.59；95%置信区间：0.38，0.90）；NG 与 NJ、TPN 和 NNS 相比，其效应量更大且排名概率更高（平均秩=1.7；SUCRA=75.8）。TPN 是最不受欢迎的选择（平均秩=3.2；SUCRA=26.6）。
NG 和 NJ 可能是治疗 AP 患者的首选治疗方法。临床医生可能会考虑将 NG 作为 AP（包括重症 AP）患者的一线治疗方法，甚至在接受预防性抗生素治疗的患者中也可考虑。此外，我们发现严重 AP 患者应避免使用 NNS。
