肠内营养辅助治疗压疮效果的荟萃分析

摘要

Objective:To evaluate the effect of enteral nutrition adjuvant therapy in the treatment of the patients with pressure ulcer,and to provide evidence based basis for guilding the reasonable supplementary nutrition for patients with pressure ulcer.Methods:The“pressure ulcer treatment,”“enteral nutrition”related to the English and Chinese key words were used,searching the relevant random controlled trials in Cochrane library,JBI sys-tem evaluation database,MEDLINE,EMbase(Web of Science),CBMdisc,CNKI,and the WanFang database,and screening for the reference literatures.Based on the inclusion and exclusion criteria,3 investigators independent-ly screened and evaluated the quality of the literatures and extracted data strictly.The RevMan 5 .0 software was used to analyze the literatures meeting the quality standards.Results:A total of 9 randomized controlled trials with total 793 cases (397 patients in experimental group,396 cases in control group)were included.Mate analysis re-sults showed that enteral nutrition could reduce the area of pressure ulcer[SMD was-0.93,95%CI(-1.40,-0.46)], reduce the healing score of pressure ulcer,and promote the healing of pressure ulcers,but could not increase the cure rate of patients with pressure ulcer[RR was1.46,95%CI(1.00,2.12)].At the same time,the incidence of adverse reactions in patients with pressure ulcer was not increased[RR was 1.12,95%CI(0.38,3.31)],which indicated that the enteral nutrition was safe.Conclusion:The enteral nutrition could reduce the area of pressure ulcer and promote it healing,and could not improve the cure rate of pressure ulcer.However,due to the limited sample size,it need to be further verified by high quality and large sample of randomized controlled trials.%[目的]系统评价肠内营养辅助治疗压疮的效果,为指导压疮病人合理补充营养提供循证依据。[方法]使用“压疮治疗”“肠内营养”相关的中英文关键词,检索 Cochrane 图书馆、JBI 系统评价数据库、MEDLine、(Web of Science)、EMbase、CBMdisc、CNKI 和万方数据库中相关的随机对照试验,同时筛检纳入文献的参考文献。由3名研究者按纳入和排除标准独立筛选并对文献质量进行严格评价和资料提取,对符合质量标准的文献采用 RevMan5.0软件进行 Meta分析。[结果]共纳入9篇随机对照试验共计793例病人(试验组397例,对照组396例),Mate分析结果显示肠内营养可缩小压疮面积[SMD为-0.93,95%CI(-1.40,-0.46)]、减少压疮的愈合计分,对压疮愈合有促进作用；但不能增加压疮病人的治愈率[RR为1.46,95%CI(1.00,2.12)],同时不会增加压疮病人的不良反应发生率[RR为1.12,95%CI(0.38,3.31)],表明肠内营养剂是安全的。[结论]肠内营养支持能缩小压疮面积和促进压疮愈合,不能提高压疮治愈率。但由于样本量有限,还需高质量、大样本的随机对照试验予以进一步验证。