Enteral Nutrition within 48 Hours of Admission Improves Clinical Outcomes of Acute Pancreatitis by Reducing Complications: A Meta-Analysis
Enteral Nutrition within 48 Hours of Admission Improves Clinical Outcomes of Acute Pancreatitis by Reducing Complications: A Meta-Analysis
复制标题
入院 48 小时内肠内营养通过减少并发症改善急性胰腺炎的临床结果：荟萃分析
DOI：
10.1371/journal.pone.0064926
复制
发表时间：
2013-06-06
期刊：
影响因子：
3.7
通讯作者：
Chen, Qi-Kui
中科院分区：
文献类型：
--
作者：
Li, Jie-Yao;Yu, Tao;Chen, Qi-Kui
背景肠内营养在急性胰腺炎的治疗中越来越受到提倡，但其时机仍然存在争议。这项荟萃分析的目的是找出入院后48小时内早期肠内营养的可行性及其可能的优势。方法和结果我们检索了PubMed、EMBASE数据库、Web of Science、科克伦图书馆和www.example.com，以获得从入院到2012年12月关于入院48小时内开始肠内营养对急性胰腺炎临床结局影响的所有相关文章。分析了11项包含775例急性胰腺炎患者的研究。对所有研究的汇总分析结果表明，早期肠内营养与总体上所有感染的显著减少相关（OR 0.38; 95%CI 0.21 - 0.68，P <0.05），导管相关脓毒症并发症胰腺感染的OR为0.26，95%CI为0.11-0.58，P <0.05（OR 0.49; 95%CI 0.31-0.78，P <0.05），高血糖组（OR 0.24，95%CI 0.11-0.52，P <0.05），住院时间（平均差异-2.18; 95%CI-3.48-（-0.87）; P <0.05）和死亡率（OR 0.31; 95%CI 0.14 - 0.71，P <0.05），但肺部并发症无差异（P> 0.05）。根据疾病严重程度分层分析显示，即使在预测的重症或重症急性胰腺炎患者中，早期肠内营养对所有感染并发症、导管相关脓毒症、胰腺感染并发症以及仅在疾病严重发作时报告的器官衰竭仍显示出整体保护能力（均P <0.05）。结论急性胰腺炎患者入院后48 h内给予肠内营养是可行的，可减少并发症的发生，改善临床预后。
Background Enteral nutrition is increasingly advocated in the treatment of acute pancreatitis, but its timing is still controversial. The aim of this meta-analysis was to find out the feasibility of early enteral nutrition within 48 hours of admission and its possible advantages. Methods and Findings We searched PubMed, EMBASE Databases, Web of Science, the Cochrane library, and scholar.google.com for all the relevant articles about the effect of enteral nutrition initiated within 48 hours of admission on the clinical outcomes of acute pancreatitis from inception to December 2012. Eleven studies containing 775 patients with acute pancreatitis were analyzed. Results from a pooled analysis of all the studies demonstrated that early enteral nutrition was associated with significant reductions in all the infections as a whole (OR 0.38; 95%CI 0.21–0.68, P<0.05), in catheter-related septic complications (OR 0.26; 95%CI 0.11–0.58, P<0.05), in pancreatic infection (OR 0.49; 95%CI 0.31–0.78, P<0.05), in hyperglycemia (OR 0.24; 95%CI 0.11–0.52, P<0.05), in the length of hospitalization (mean difference −2.18; 95%CI −3.48−(−0.87); P<0.05), and in mortality (OR 0.31; 95%CI 0.14–0.71, P<0.05), but no difference was found in pulmonary complications (P>0.05). The stratified analysis based on the severity of disease revealed that, even in predicted severe or severe acute pancreatitis patients, early enteral nutrition still showed a protective power against all the infection complications as a whole, catheter-related septic complications, pancreatic infection complications, and organ failure that was only reported in the severe attack of the disease (all P<0.05). Conclusion Enteral nutrition within 48 hours of admission is feasible and improves the clinical outcomes in acute pancreatitis as well as in predicted severe or severe acute pancreatitis by reducing complications.