中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
35期
2786-2789
,共4页
谢剑锋%黄力维%郭凤梅%杨毅%邱海波
謝劍鋒%黃力維%郭鳳梅%楊毅%邱海波
사검봉%황력유%곽봉매%양의%구해파
肠营养%交叉感染%肺炎%通气机,负压%死亡率
腸營養%交扠感染%肺炎%通氣機,負壓%死亡率
장영양%교차감염%폐염%통기궤,부압%사망솔
Enteral nutrition%Cross infection%Pneumonia%Ventilator,negative-pressure%Mortality
目的 观察经小肠营养能否降低医院获得性肺炎(HAP)发生率.方法 通过计算机检索数据库收集1992年1月至2012年9月关于比较经胃营养与经小肠营养对HAP发生率影响的随机对照研究,然后采用RevMan 5.0软件对纳入资料进行系统分析,明确不同途径的营养方式对HAP的影响.结果 共纳入10项随机对照的临床研究,830例患者；其中6个研究分析了经小肠营养对呼吸机相关性肺炎(VAP)的影响.两组HAP发生率分别为15％(62/407)及23％(97/427).与经胃营养相比,经小肠营养明显降低HAP的发生率[RR 0.67,95％ CI(0.51 ～0.89),P=0.005；I2=0％)],但不降低患者住院病死率[RR l.08,95％ CI(0.84～1.40),P=0.54;I2 =0％]及ICU住院时间[Weighted mean difference 0.04 d,95％CI(-2.83 ～2.91),P=0.98;I2 =96％].亚组分析显示经小肠营养明显降低VAP的发生率[RR0.64,95％ CI(0.46～0.90),P=0.01；I2=9％)],但不降低非VAP的HAP发生率[RR0.74,95％CI(0.45 ～ 1.21),P=0.23；I2=0％)].结论 与经胃营养相比,经小肠营养可以显著降低HAP发生率,尤其降低VAP发生率,但不降低患者住院病死率.
目的 觀察經小腸營養能否降低醫院穫得性肺炎(HAP)髮生率.方法 通過計算機檢索數據庫收集1992年1月至2012年9月關于比較經胃營養與經小腸營養對HAP髮生率影響的隨機對照研究,然後採用RevMan 5.0軟件對納入資料進行繫統分析,明確不同途徑的營養方式對HAP的影響.結果 共納入10項隨機對照的臨床研究,830例患者；其中6箇研究分析瞭經小腸營養對呼吸機相關性肺炎(VAP)的影響.兩組HAP髮生率分彆為15％(62/407)及23％(97/427).與經胃營養相比,經小腸營養明顯降低HAP的髮生率[RR 0.67,95％ CI(0.51 ～0.89),P=0.005；I2=0％)],但不降低患者住院病死率[RR l.08,95％ CI(0.84～1.40),P=0.54;I2 =0％]及ICU住院時間[Weighted mean difference 0.04 d,95％CI(-2.83 ～2.91),P=0.98;I2 =96％].亞組分析顯示經小腸營養明顯降低VAP的髮生率[RR0.64,95％ CI(0.46～0.90),P=0.01；I2=9％)],但不降低非VAP的HAP髮生率[RR0.74,95％CI(0.45 ～ 1.21),P=0.23；I2=0％)].結論 與經胃營養相比,經小腸營養可以顯著降低HAP髮生率,尤其降低VAP髮生率,但不降低患者住院病死率.
목적 관찰경소장영양능부강저의원획득성폐염(HAP)발생솔.방법 통과계산궤검색수거고수집1992년1월지2012년9월관우비교경위영양여경소장영양대HAP발생솔영향적수궤대조연구,연후채용RevMan 5.0연건대납입자료진행계통분석,명학불동도경적영양방식대HAP적영향.결과 공납입10항수궤대조적림상연구,830례환자；기중6개연구분석료경소장영양대호흡궤상관성폐염(VAP)적영향.량조HAP발생솔분별위15％(62/407)급23％(97/427).여경위영양상비,경소장영양명현강저HAP적발생솔[RR 0.67,95％ CI(0.51 ～0.89),P=0.005；I2=0％)],단불강저환자주원병사솔[RR l.08,95％ CI(0.84～1.40),P=0.54;I2 =0％]급ICU주원시간[Weighted mean difference 0.04 d,95％CI(-2.83 ～2.91),P=0.98;I2 =96％].아조분석현시경소장영양명현강저VAP적발생솔[RR0.64,95％ CI(0.46～0.90),P=0.01；I2=9％)],단불강저비VAP적HAP발생솔[RR0.74,95％CI(0.45 ～ 1.21),P=0.23；I2=0％)].결론 여경위영양상비,경소장영양가이현저강저HAP발생솔,우기강저VAP발생솔,단불강저환자주원병사솔.
Objective To explore whether or not small bowel feeding can reduce the incidence of hospital acquired pneumonia (HAP).Methods The databases of Pubmed,Embase and Web of Science were searched to identify the relevant randomized controlled trials (RCT) from January 1992 to September 2012.Meta analysis was performed to analyze the effects of gastric versus small bowel feeding on HAP.Results Ten RCTs including 830 patients were retrieved and 6 of which examined the effect of ventilatorassociated pneumonia (VAP).In total,the incidence of HAP was 15％ (62/407) in bowel feeding group versus 23％ (97/423) in gastric feeding group.As compared with gastric feeding,small bowel feeding appeared to significantly reduce the incidence of HAP [RR 0.67,95％ CI(0.51-0.89),P =0.005 ; I2 =0％)],but did not reduce the mortality [RR 1.08,95％ CI(0.84-1.40),P =0.54; I2 =0％] and the duration of ICU stay [weighted mean difference in 0.04 days,95％ CI(-2.83-2.91),P =0.98; I2 =96％].Subgroup analysis indicated that small bowel nutrition reduced the incidence of VAP [RR 0.64,95％CI(0.46-0.90),P =0.01 ; I2 =9％)],but did not reduce the incidence HAP of non-VAP [RR0.74,95％CI(0.45-1.21),P=0.23; I2 =0％)].Conclusion Compared with gastric feeding,small bowel feeding can reduce the incidence of HAP,especially VAP,but can not reduce the mortality.
