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危重症患者肠内营养不耐受的危险因素：一项更新的系统评价和荟萃分析

Risk factors for enteral feeding intolerance in critically ill patients: an updated systematic review and meta-analysis.

作者信息

Wang Si, He Yang, Yi Jing, Sha Liyan

机构信息

Interventional Surgery Center, The Second Hospital of Dalian Medical University, Dalian, Liaoning, 116000, China.

School of Nursing, Dalian Medical University, Dalian, Liaoning, 116000, China.

出版信息

BMC Gastroenterol. 2025 Apr 8;25(1):233. doi: 10.1186/s12876-025-03837-8.

DOI:10.1186/s12876-025-03837-8
PMID:40200147
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11980324/
Abstract

BACKGROUND

This meta-analysis aimed to evaluate the factors influencing enteral nutrition feeding intolerance in critically ill patients.

METHODS

PubMed, Embase, Scopus, Medline, Web of Science, CNKI, VIP, WanFang and CBM databases were searched. A sensitivity analysis was carried out to explore the influence of individual studies on the pooled results of the included studies using a fixed-effects model or a random-effects model. The pooled results were expressed as the odds ratios (ORs) and 95% confidence intervals (Cls). Finally, a funnel plot was developed to describe the publication bias.

RESULTS

Twenty-three studies involving 30,688 participants were included. Meta-analysis results showed that age, body mass index (BMI), APACHE II score, renal insufficiency, digestive system diseases, hypoproteinemia, sepsis, and post-pyloric feeding, starting feeding within 48 h, feeding pattern, nutritional formula, sedative drugs, vasoactive drugs, use of more than two antibiotics, oral potassium preparation, mechanical ventilation, days of mechanical ventilation, length of ICU stay, and mortality were the influencing factors of enteral nutrition feeding intolerance in critically ill patients. The results of the sensitivity analysis showed that the direction of the pooled effect size did not change after excluding each study one by one, suggesting that the results of the meta-analysis were robust.

CONCLUSIONS

According to the influencing factors, medical staff can pay attention to the high-risk patients at ICU admission to reduce the risk of feeding intolerance.

摘要

背景

本荟萃分析旨在评估影响重症患者肠内营养喂养不耐受的因素。

方法

检索了PubMed、Embase、Scopus、Medline、Web of Science、中国知网（CNKI）、维普资讯（VIP）、万方数据库和中国生物医学文献数据库（CBM）。采用固定效应模型或随机效应模型进行敏感性分析，以探讨单个研究对纳入研究汇总结果的影响。汇总结果以比值比（OR）和95%置信区间（CI）表示。最后，绘制漏斗图以描述发表偏倚。

结果

纳入了23项研究，共30688名参与者。荟萃分析结果表明，年龄、体重指数（BMI）、急性生理与慢性健康状况评分系统II（APACHE II）评分、肾功能不全、消化系统疾病、低蛋白血症、脓毒症、幽门后喂养、48小时内开始喂养、喂养方式、营养配方、镇静药物、血管活性药物、使用两种以上抗生素、口服钾制剂、机械通气、机械通气天数、重症监护病房（ICU）住院时间和死亡率是重症患者肠内营养喂养不耐受的影响因素。敏感性分析结果表明，逐一排除每项研究后，汇总效应量的方向未改变，表明荟萃分析结果具有稳健性。

结论

根据影响因素，医护人员可在患者入住ICU时关注高危患者，以降低喂养不耐受的风险。

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