West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Eur J Clin Nutr. 2022 Apr;76(4):592-603. doi: 10.1038/s41430-021-00986-3. Epub 2021 Jul 23.
BACKGROUND/OBJECTIVES: Whether to conduct early enteral nutrition combined with probiotics (EEN/probiotics) in stroke patients remains controversial. This study was aimed to systematically explore the efficacy and safety of EEN/probiotics in stroke patients.
SUBJECT/METHODS: We performed searches in EMBASE, PubMed, Medline, Cochrane Library, Chinese Biomedicine Literature Database (SinoMed), Chinese Scientific Journal Database (VIP), Chinese National Knowledge Infrastructure (CNKI) and Wanfang database.
A total of 26 randomized controlled trials (2216 patients) were included. Meta-analysis showed a significantly lower incidence of gastrointestinal complications (%) (OR, 0.29; 95% CI,0.24-0.36; P < 0.00001), a lower incidence of infection (%) (OR, 0.27; 95% CI, 0.21-0.36; P < 0.00001), a shorter length of hospital stay (d) (MD, -8.70; 95% CI, -13.24 to -4.16; P = 0.003), and a lower dysbacteriosis rate (%) (OR, 0.17; 95% CI, 0.07-0.41; P < 0.0001) in the EEN/probiotics group than EEN group. Compared with EEN group, EEN/probiotics group had lower levels of diamine oxidase (U/L) (MD, -0.78; 95% CI, -0.93 to -0.63; P < 0.00001), D-lactic acid (mmol/L) (MD, -0.06; 95% CI, -0.07 to -0.05; P < 0.00001) and higher levels of albumin (g/L) (MD, 3.38; 95% CI, 2.74-4.02; P < 0.00001), prealbumin (mg/L) (MD, 32.20; 95% CI, 24.42-39.98; P < 0.00001), total protein (g/L) (MD, 4.91; 95% CI, 3.20-6.62; P < 0.00001), hemoglobin (g/L) (MD, 9.62; 95% CI, 7.92-11.32; P < 0.00001), immunoglobulin A (g/L) (MD, 0.23; 95% CI, 0.12-0.34; P < 0.0001) and immunoglobulin G (g/L) (MD, 0.33; 95% CI, 0.21-0.45; P < 0.00001).
Early enteral nutrition combined with probiotics may effectively improve the nutritional status of stroke patients, regulate the intestinal flora and intestinal mucosal barrier function, improve the immune function, reduce the incidence of infectious complications and gastrointestinal motility disorders.
背景/目的：对于脑卒中患者是否应进行早期肠内营养联合益生菌（EEN/probiotics）治疗，目前仍存在争议。本研究旨在系统地探讨 EEN/probiotics 对脑卒中患者的疗效和安全性。
我们在 EMBASE、PubMed、Medline、Cochrane Library、中国生物医学文献数据库（SinoMed）、中国科学引文数据库（VIP）、中国知网（CNKI）和万方数据库中进行了检索。
共纳入 26 项随机对照试验（2216 例患者）。Meta 分析显示，EEN/probiotics 组胃肠道并发症发生率（%）[比值比（OR），0.29；95%置信区间（CI），0.24-0.36；P<0.00001]、感染发生率（%）（OR，0.27；95%CI，0.21-0.36；P<0.00001）、住院时间（d）（MD，-8.70；95%CI，-13.24 至-4.16；P=0.003）和肠道菌群失调发生率（%）（OR，0.17；95%CI，0.07-0.41；P<0.0001）显著低于 EEN 组。与 EEN 组相比，EEN/probiotics 组二胺氧化酶（U/L）（MD，-0.78；95%CI，-0.93 至-0.63；P<0.00001）、D-乳酸（mmol/L）（MD，-0.06；95%CI，-0.07 至-0.05；P<0.00001）水平更低，白蛋白（g/L）（MD，3.38；95%CI，2.74-4.02；P<0.00001）、前白蛋白（mg/L）（MD，32.20；95%CI，24.42-39.98；P<0.00001）、总蛋白（g/L）（MD，4.91；95%CI，3.20-6.62；P<0.00001）、血红蛋白（g/L）（MD，9.62；95%CI，7.92-11.32；P<0.00001）、免疫球蛋白 A（g/L）（MD，0.23；95%CI，0.12-0.34；P<0.0001）和免疫球蛋白 G（g/L）（MD，0.33；95%CI，0.21-0.45；P<0.00001）水平更高。
早期肠内营养联合益生菌治疗可能有效改善脑卒中患者的营养状况，调节肠道菌群和肠黏膜屏障功能，提高免疫功能，降低感染性并发症和胃肠动力障碍的发生率。
