Meta-analysis: Total Parenteral Nutrition Versus Total Enteral Nutrition in Predicted Severe Acute Pancreatitis
Meta-analysis: Total Parenteral Nutrition Versus Total Enteral Nutrition in Predicted Severe Acute Pancreatitis
复制标题
DOI：
10.2169/internalmedicine.51.6685
复制
发表时间：
2012-01-01
影响因子：
1.2
通讯作者：
Xia, Bing
中科院分区：
文献类型：
--
作者：
Yi, Fengming;Ge, Liuqing;Xia, Bing
研究背景全肠外营养（TPN）作为治疗重症急性胰腺炎的传统模式，目前仍广泛应用于临床。此外，肠内营养治疗方法也有所发展;早期肠内营养已经被强调用于重症急性胰腺炎，但是治疗风险与益处需要被研究。目的和目的通过执行荟萃分析比较全肠外营养与全肠内营养（TEN）在重症急性胰腺炎患者中的作用。材料和方法电子数据库包括PubMed、EMBASE、Science Citation Index、检索相关的随机对照试验。两名评价者独立地确定了评价全肠外营养和早期肠内营养效果的相关试验。结果共纳入8项随机对照试验（RCTs），共纳入381例患者。荟萃分析表明，在考虑死亡率时，TEN显著上级TPN [p=0.001，95% CI 0.37（0.21-0.68）]，感染并发症[p=0.004，95% CI 0.46（0.27-0.78）]、器官衰竭[p=0.02，95% CI 0.44（0.22-0.88）]和手术干预[p=0.003，95% CI 0.41（0.23-0.74）]。而考虑住院时间时，TEN和TPN之间没有差异[p=0.22，95%CI-14.10（-36.48-8.26）]和营养持续时间[p=0.72，95% CI -1.50结论全肠内营养支持可降低病死率，与肠外营养支持相比，感染并发症少，器官衰竭和手术干预率低。
Background Total parenteral nutrition (TPN) as a traditional mode of treatment in severe acute pancreatitis was still used widely in clinical work. In addition, enteral nutrition treatment methods have developed; early enteral nutrition has already been highlighted for severe acute pancreatitis, but the therapeutic risks versus benefits need to be studied.Aims and Objective To compare total parenteral nutrition with total enteral nutrition (TEN) in patients with severe acute pancreatitis by performing a meta-analysis.Materials and Methods Electronic databases including PubMed, EMBASE, Science Citation Index, were searched to find relevant randomized controlled trials. Two reviewers independently identified relevant trials evaluating the effect of total parenteral nutrition and early enteral nutrion. Outcome measures were the mortality, hospital length of stay, infectious complications, duration of nutrition, organ failure and surgical intervention.Results Eight randomized controlled trials (RCTs) including 381 patients were identified. Meta-analysis demonstrated that TEN was significantly superior to TPN when considering mortality [p=0.001, 95% CI 0.37 (0.21-0.68)], infectious complications [p=0.004, 95% CI 0.46(0.27-0.78)], organ failure [p=0.02, 95% CI 0.44 (0.22-0.88)] and surgical intervention [p=0.003, 95% CI 0.41(0.23-0.74)]. While no difference between TEN and TPN when considering the hospital length of stay [p=0.22, 95% CI -14.10(-36.48-8.26)] and as for duration of nutrition [p=0.72, 95% CI -1.50(-9.56-6.56)] there was not enough data to compare the differences.Conclusion Total enteral nutritional support is associated with lower mortality, fewer infectious complications, decreased organ failure and surgical intervention rate compared to parenteral nutritional support.