Yao Qian, Liu Pi, Peng Siyang, Xu Xuan, Wu Yanping
Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China.
Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China.
Pancreatology. 2022 Mar;22(2):175-184. doi: 10.1016/j.pan.2021.11.009. Epub 2021 Dec 1.
The timing of oral refeeding can affect length of stay (LOS) and recovery of acute pancreatitis (AP). However, the optimal timing for oral refeeding is still controversial for AP. This meta-analysis investigated the effects of immediate or early versus delayed oral feeding on mild and moderate AP, regardless of improvement in clinical signs or laboratory indicators.
This systematic review and meta-analysis of randomized controlled trials (RCTs) based on data from Embase, Cochrane Library, PubMed, Web of science, and CBM before August 2021. Two researchers independently used Stata16 to extract and analyse study data. Random effect model was performed for meta-analysis to calculate the risk ratio (RR) and standardized mean difference (SMD).
8 RCTs were selected, including 748 patients with mild to moderate AP. Patients in IOR (Immediate or early Oral Refeeding) group had less costs [SMD -0.83, 95%CI (-1.17, -0.5), P < 0.001] and shorter LOS [SMD -1.01, 95%CI (-1.17, -0.85), P < 0.001] than the DOR (Delayed Oral Refeeding) group patients. However, there was no difference in mortality [RR 0.54, 95%CI (0.11, 2.62), P = 0.44], pain relapse rate [RR 0.58, 95%CI (0.25, 1.35), P = 0.27], feeding intolerance rate [RR 0.61, 95%CI (0.28, 1.3), P = 0.2], AP progression rate [RR 0.21, 95%CI (0.04, 1.07), P = 0.06] and overall complications rate [RR 0.41, 95%CI (0.17, 1.01), P = 0.05] between the IOR and DOR groups.
Limited data suggest that IOR could reduce LOS and costs without increasing adverse events in mild to moderate AP.
口服再喂养的时机可影响急性胰腺炎（AP）的住院时间（LOS）和恢复情况。然而，AP口服再喂养的最佳时机仍存在争议。本荟萃分析探讨了立即或早期与延迟口服喂养对轻度和中度AP的影响，而不考虑临床体征或实验室指标的改善情况。
基于2021年8月之前来自Embase、Cochrane图书馆、PubMed、科学网和中国生物医学文献数据库的数据，对随机对照试验（RCT）进行了系统评价和荟萃分析。两名研究人员独立使用Stata16提取和分析研究数据。采用随机效应模型进行荟萃分析，以计算风险比（RR）和标准化均数差（SMD）。
共纳入8项RCT，包括748例轻度至中度AP患者。与延迟口服再喂养（DOR）组患者相比，立即或早期口服再喂养（IOR）组患者的费用更低[SMD -0.83，95%CI（-1.17，-0.5），P < 0.001]，住院时间更短[SMD -1.01，95%CI（-1.17，-0.85），P < 0.001]。然而，IOR组和DOR组在死亡率[RR 0.54，95%CI（0.11，2.62），P = 0.44]、疼痛复发率[RR 0.58，95%CI（0.25，1.35），P = 0.27]、喂养不耐受率[RR 0.61，95%CI（0.28，1.3），P = 0.2]、AP进展率[RR 0.21，95%CI（0.04，1.07），P = 0.06]和总体并发症发生率[RR 0.41，95%CI（0.17，1.01），P = 0.05]方面无差异。
有限的数据表明，在轻度至中度AP中，立即或早期口服再喂养可减少住院时间和费用，而不增加不良事件。
