经鼻胃管与鼻空肠管营养在重症急性胰腺炎中应用的Meta分析

摘要

目的 分析鼻胃管与鼻空肠管两种肠内营养方式在重症急性胰腺炎中的疗效.方法 检索外文数据库PubMed、Wiley、Elseviser、Springer Link及中文数据库中国期刊全文数据库(CNKI)、中国科技期刊数据库(VIP)、万方数字化期刊全文数据库中关于鼻胃管与鼻空肠管两种肠内营养方式比较治疗重症急性胰腺炎的随机对照试验,由两个评价员对文献进行评价,意见不统一时通过讨论解决或由第三者判断.采用RevMan5.3软件对纳入研究进行Meta分析.结果 共有6项随机对照试验纳入本研究,共纳入研究对象326例,其中NGEN组166例,NJEN组160例.分析结果显示:NGEN组在病死率(OR =0.82,95％ CI0.40～1.68,P=0.59)、营养相关性腹泻(OR =1.36,95％ CI 0.57～3.24,P=0.49)、营养相关性腹痛(OR=1.43,95％ CI 0.64～3.21,P=0.39)、手术干预率(OR =2.03,95％ CI 0.48～8.57,P=0.34)、置管脱出率(OR=0.39,95％ CI0.07～2.29,P=0.30)、胰腺坏死(OR =0.87,95％ CI 0.45～1.68,P=0.68)等方面与NJEN组差异无统计学意义;而感染性并发症(OR =0.46,95％ CI 0.24～0.88,P=0.02)鼻胃管组显著低于鼻空肠管组.结论 鼻胃管给予营养可以达到与鼻空肠管相似的疗效,且操作方便,费用低廉,在感染性并发症发生率方面优于后者,具有代替鼻空肠管的可能性.%Objective To analyze the efficacy of nasogastric enteral nutrition (NGEN) and nasojejunal enteral nutrition (NJEN) for severe acute pancreatitis(SAP).Methods PubMed,Wiley,Elseviser,Springer Link and Chinese Journals Full-text Database(CNKI),Database for Chinese Technical Periodicals(VIP) and Wanfang Digital Journal Full-text Database from 2000 to 2016 (up to March)were retrieved to collect clinical randomized controlled trials (RCT)of NGEN to compare with NJEN in the treatment of SAP.Two reviewers assessed the quality of each study independently and collected data.Different opinions were resolved by discussion among the two reviewers or the third authors of the paper.Statistical analysis was performed by Review Manager 5.3.Results Six RCT was included involving 326 patients with SAP.There are 166 and 160 patients in NGEN group and NJEN group respectively.Analysis results shows that there are no difference in mortality of SAP(OR =0.82,95％CI 0.40 ～ 1.68,P =0.59);diarrhea subsequent to enteral nutrition(OR =1.36,95％CI 0.57 ～ 3.24,P =0.49);pain related with enteral nutrition(OR =1.43,95％CI 0.64 ～ 3.21,P =0.39);conversion to surgery(OR =2.03,95％CI 0.48 ～ 8.57,P =0.34);rate of tube displacement(OR =0.39,95％CI 0.07 ～ 2.29,P =0.30);However,the infectious complications in NGEN was lower than NJEN(OR =0.46,95％CI 0.24 ～ 0.88,P =0.02).Conclusion The efficacy of NGEN is comparable to NJEN for patients with SAP,and superior to NJEN in infectious complications,and easier to operate and cheaper.NGEN may replace NJEN in the future.