基于容量的喂养（VBF）方案对危重症患者的疗效：一项荟萃分析和系统评价。

Efficacy of volume-based feeding (VBF) protocol on critically ill patients: A meta-analysis and systematic review.

机构信息

Sichuan Provincial Center for Emergency Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, China.

Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Province, China.

出版信息

Asia Pac J Clin Nutr. 2021 Sep;30(3):392-400. doi: 10.6133/apjcn.202109_30(3).0006.

DOI:10.6133/apjcn.202109_30(3).0006

PMID:34587699

Abstract

BACKGROUND AND OBJECTIVES

We aim to evaluate the efficacy and safety of VBF on critically ill patients.

METHODS AND STUDY DESIGN

We systematically retrieved the related literature from January 1, 2000, to March 30, 2021, sources include MEDLINE, Wed of Science, Cochrane Library and China National Knowledge Infrastructure. Randomized controlled trials or cohort studies of enteral nutrition based on VBF versus rate-based feeding (RBF) in critically illness of adult participants were selected.

RESULTS

After screening, seven studies involving 691 patients were finally included. Six of them were high quality. The percentage of goal energy received in the VBF group was significantly high-er than that in the RBF group [MD=9.11, 95% CI (5.82, 12.41), p<0.001]. ICU length of stay in the VBF group [MD=-0.8, 95% CI (-1.59, -0.01), p=0.05], mechanical ventilation length [MD=- 1.27, 95% CI (-2.04, -0.51), p=0.001] were significantly shorter in the VBF group, but hospital length of stay [MD=0.62, 95% CI (-4.46, 5.69), p=0.81] was not significantly different. Our study shows that VBF has some non-significant advantages in reducing mortality [RR=0.70, 95% CI (0.44, 1.11), p=0.13]. The rates of adverse reactions, such as diarrhea RR=1.17, 95% CI (0.91, 1.50), p=0.23), emesis (RR=0.80, 95% CI (0.42, 1.55), p=0.51), feeding intolerance [RR=0.97, 95% CI (0.64, 1.48), p=0.90) were not significantly different between the two groups.

CONCLUSIONS

The VBF protocol significantly improves the successive rate of enteral nutrition in critically ill patients.

摘要

背景与目的

本研究旨在评估 VBF 对危重症患者的疗效和安全性。

方法与研究设计

我们系统地检索了 2000 年 1 月 1 日至 2021 年 3 月 30 日的相关文献，包括 MEDLINE、Web of Science、Cochrane 图书馆和中国知网。纳入了基于 VBF 与基于速率的喂养（RBF）的危重症成年患者肠内营养的随机对照试验或队列研究。

结果

经过筛选，最终纳入了 7 项研究，共涉及 691 名患者。其中 6 项研究质量较高。VBF 组目标能量的接受率显著高于 RBF 组[MD=9.11，95%CI（5.82，12.41），p<0.001]。VBF 组 ICU 住院时间[MD=-0.8，95%CI（-1.59，-0.01），p=0.05]和机械通气时间[MD=-1.27，95%CI（-2.04，-0.51），p=0.001]明显缩短，但住院时间[MD=0.62，95%CI（-4.46，5.69），p=0.81]无显著差异。本研究表明，VBF 在降低死亡率方面具有一定的非显著性优势[RR=0.70，95%CI（0.44，1.11），p=0.13]。两组不良反应发生率如腹泻[RR=1.17，95%CI（0.91，1.50），p=0.23]、呕吐[RR=0.80，95%CI（0.42，1.55），p=0.51]、喂养不耐受[RR=0.97，95%CI（0.64，1.48），p=0.90]差异无统计学意义。