中华危重症医学杂志（电子版）
中華危重癥醫學雜誌（電子版）
중화위중증의학잡지（전자판）
CHINESE JOURNAL OF CRITICAL CARE MEDICINE ( ELECTRONIC EDITON)
2015年
1期
29-34
,共6页
神经系统疾病%危重病%肠内营养%胃内营养%Meta分析
神經繫統疾病%危重病%腸內營養%胃內營養%Meta分析
신경계통질병%위중병%장내영양%위내영양%Meta분석
Nervous system diseases%Critical illness%Enternal and nutrition%Entogastric nutrition%Meta-analysis
目的：系统评价肠内营养和胃内营养对危重神经系统疾病患者预后的影响。方法计算机检索Pubmed、Embase、Cochrane Library、万方数据库、中国期刊全文数据库，纳入以肠内营养和胃内营养对危重神经系统疾病患者预后影响的随机对照研究。按Cochrane系统评价方法，由2位评价员根据纳入研究标准独立对数据进行Meta分析。结果共纳入7项研究，总样本量为619例，肠内营养组310例，胃内营养组309例。Meta分析显示，肠内营养组能的吸入性肺炎发生率[RR＝0.59，95％CI（0.43，0.81）]及呕吐发生率[RR＝0.43，95％CI（0.24，0.80）]明显低于胃内营养组患者，而两组患者的每日获得的能量[WMD＝0.55，95％CI（-0.19，1.29）]，腹泻[RR＝1.01，95％CI （0.69，1.48）]、消化道出血的发生率[RR＝0.95，95％CI （0.45，2.06）]、ICU住院时间[WMD＝-1.15，95％CI（-4.37，2.07）]及病死率[RR＝0.99，95％CI（0.73，1.36）]的比较，差异均无统计学意义。结论肠内营养可降低危重神经系统疾病患者吸入性肺炎及呕吐发生率，但尚需要大样本高质量的循证医学证据。
目的：繫統評價腸內營養和胃內營養對危重神經繫統疾病患者預後的影響。方法計算機檢索Pubmed、Embase、Cochrane Library、萬方數據庫、中國期刊全文數據庫，納入以腸內營養和胃內營養對危重神經繫統疾病患者預後影響的隨機對照研究。按Cochrane繫統評價方法，由2位評價員根據納入研究標準獨立對數據進行Meta分析。結果共納入7項研究，總樣本量為619例，腸內營養組310例，胃內營養組309例。Meta分析顯示，腸內營養組能的吸入性肺炎髮生率[RR＝0.59，95％CI（0.43，0.81）]及嘔吐髮生率[RR＝0.43，95％CI（0.24，0.80）]明顯低于胃內營養組患者，而兩組患者的每日穫得的能量[WMD＝0.55，95％CI（-0.19，1.29）]，腹瀉[RR＝1.01，95％CI （0.69，1.48）]、消化道齣血的髮生率[RR＝0.95，95％CI （0.45，2.06）]、ICU住院時間[WMD＝-1.15，95％CI（-4.37，2.07）]及病死率[RR＝0.99，95％CI（0.73，1.36）]的比較，差異均無統計學意義。結論腸內營養可降低危重神經繫統疾病患者吸入性肺炎及嘔吐髮生率，但尚需要大樣本高質量的循證醫學證據。
목적：계통평개장내영양화위내영양대위중신경계통질병환자예후적영향。방법계산궤검색Pubmed、Embase、Cochrane Library、만방수거고、중국기간전문수거고，납입이장내영양화위내영양대위중신경계통질병환자예후영향적수궤대조연구。안Cochrane계통평개방법，유2위평개원근거납입연구표준독립대수거진행Meta분석。결과공납입7항연구，총양본량위619례，장내영양조310례，위내영양조309례。Meta분석현시，장내영양조능적흡입성폐염발생솔[RR＝0.59，95％CI（0.43，0.81）]급구토발생솔[RR＝0.43，95％CI（0.24，0.80）]명현저우위내영양조환자，이량조환자적매일획득적능량[WMD＝0.55，95％CI（-0.19，1.29）]，복사[RR＝1.01，95％CI （0.69，1.48）]、소화도출혈적발생솔[RR＝0.95，95％CI （0.45，2.06）]、ICU주원시간[WMD＝-1.15，95％CI（-4.37，2.07）]급병사솔[RR＝0.99，95％CI（0.73，1.36）]적비교，차이균무통계학의의。결론장내영양가강저위중신경계통질병환자흡입성폐염급구토발생솔，단상수요대양본고질량적순증의학증거。
Objective To evaluate the effect of enternal and entogastric nutrition on the outcome of severe neurologic diseases patients. Methods All randomized controlled trials (RCTs) concerning the effect of enternal and entogastric nutrition on the outcome of severe neurologic diseases patients were identified from PubMed, Embase, the Cochrane Library, Wanfang Database and CNKI. Meta-analysis was conducted by using the statistical software RevMan 5.2 and the quality of the RCTs was strictly evaluated by the Cochrane Handbook. Results A total of 7 RCTs involving 619 patients (310 patients in the enternal nutrition group and 309 patients in the entogastric nutrition group) were included in this study. The incidence of aspiration pneumonia [RR=0.59, 95%CI (0.43, 0.81)] and vomit in the enternal nutrition group [RR=0.43, 95%CI (0.24, 0.80)] were lower than those in the entogastric nutrition group. While no difference was found between the two groups in the daily caloric intake [WMD=0.55, 95%CI (-0.19, 1.29)], the incidence of diarrhea [RR=1.01, 95%CI (0.69, 1.48)], gastrointestinal bleeding [RR=0.95, 9 5%CI (0.45, 2.06)], duration of ICU stay [WMD=-1.15, 95%CI (-4.37, 2.07)] and ICU mortality [RR=0.99, 95%CI (0.73, 1.36)]. Conclusions Patients with enternal nutrition could decrease the incidence of aspiration pneumonia and vomit. However, the efficacy of enternal nutrition needs further investigation in high-quality evidence based medicine in the future.
